Abstract：
BACKGROUND: Sedative overdoses pose a delirium risk among Intensive Care Unit (ICU) patients, with potential mitigation through the use of a processed EEG monitor (BIS) to guide depth of sedation.
OBJECTIVE: Can BIS-guided deep sedation (RASS -4, -5) reduce sedative dosage and increase delirium-free and coma-free (DFCF) days?
METHODS: A randomized controlled trial was conducted in a tertiary mixed ICU, enrolling patients requiring deep sedation for >8 hours. Patients were randomly assigned to either the Clinical Assessment (CA) or BIS groups (BIS range of 40-60). Both groups utilized a BIS sensor, while the CA group\'s screen remained covered. After deep sedation, BIS sensors were removed, and delirium was assessed twice daily by researchers blinded to the randomization. The primary outcome was the number of DFCF days within 14 days after deep sedation. Additionally, we compared doses of sedative drugs and BIS values during deep sedation.
RESULTS: Ninety-nine patients were included in the study. We found no significant difference in DFCF (p=0.1) between CA and BIS arms, but propofol doses were significantly lower in the BIS group (CA group 1.77 mg/kg/hr [95% CI 1.60, 1.93] vs. BIS group 1.44 mg/kg/hr [95% CI 1.04, 1.83]; p=0.03). During deep sedation, the CA group spent 46% of the total hours (95% CI 35, 57%) with BIS values below 40, whereas the BIS group spent 32% (95% CI 25, 40%), (p=0.03). Subgroup analysis focusing on patients sedated for more than 24 hours revealed an increase in DFCF in the BIS group (CA group median of 1 day [IQR 0, 9] vs. BIS group 8 days [IQR 0, 13]; p=0.04).
CONCLUSIONS: BIS-guided deep sedation did not improve DFCF days but reduced sedative drug use. In patients requiring sedation for more than 24 hours, it showed an improvement in DFCF days.
OBJECTIVE: Can BIS-guided deep sedation (RASS -4, -5) reduce sedative dosage and increase delirium-free and coma-free (DFCF) days?
METHODS: A randomized controlled trial was conducted in a tertiary mixed ICU, enrolling patients requiring deep sedation for >8 hours. Patients were randomly assigned to either the Clinical Assessment (CA) or BIS groups (BIS range of 40-60). Both groups utilized a BIS sensor, while the CA group\'s screen remained covered. After deep sedation, BIS sensors were removed, and delirium was assessed twice daily by researchers blinded to the randomization. The primary outcome was the number of DFCF days within 14 days after deep sedation. Additionally, we compared doses of sedative drugs and BIS values during deep sedation.
RESULTS: Ninety-nine patients were included in the study. We found no significant difference in DFCF (p=0.1) between CA and BIS arms, but propofol doses were significantly lower in the BIS group (CA group 1.77 mg/kg/hr [95% CI 1.60, 1.93] vs. BIS group 1.44 mg/kg/hr [95% CI 1.04, 1.83]; p=0.03). During deep sedation, the CA group spent 46% of the total hours (95% CI 35, 57%) with BIS values below 40, whereas the BIS group spent 32% (95% CI 25, 40%), (p=0.03). Subgroup analysis focusing on patients sedated for more than 24 hours revealed an increase in DFCF in the BIS group (CA group median of 1 day [IQR 0, 9] vs. BIS group 8 days [IQR 0, 13]; p=0.04).
CONCLUSIONS: BIS-guided deep sedation did not improve DFCF days but reduced sedative drug use. In patients requiring sedation for more than 24 hours, it showed an improvement in DFCF days.
摘要：
背景：在重症监护病房（ICU）患者中，镇静过量会带来谵妄风险，通过使用经过处理的EEG监测器（BIS）来指导镇静深度，具有潜在的缓解作用。
目的：BIS引导的深度镇静（RASS-4，-5）能否减少镇静剂量并增加无谵妄和无昏迷（DFCF）的天数？
方法：在三级混合ICU进行了一项随机对照试验，招募需要深度镇静>8小时的患者。患者被随机分配到临床评估（CA）或BIS组（BIS范围为40-60）。两组均使用BIS传感器,而CA组的屏幕保持覆盖。深度镇静后,拆卸BIS传感器,研究人员对随机分组不知情,每天两次评估谵妄.主要结果是深度镇静后14天内的DFCF天数。此外,我们比较了深度镇静期间镇静药物的剂量和BIS值.
结果：九十九名患者被纳入研究。我们发现CA和BIS臂之间的DFCF没有显着差异（p=0.1），但BIS组的异丙酚剂量明显较低（CA组1.77mg/kg/hr[95％CI1.60，1.93]vs.BIS组1.44mg/kg/hr[95%CI1.04,1.83];p=0.03)。在深度镇静期间，CA组花费的总时间为46％（95％CI35，57％），BIS值低于40，而BIS组花费的时间为32％（95％CI25，40％），（p=0.03）。针对镇静超过24小时的患者的亚组分析显示，BIS组的DFCF增加（CA组中位数为1天[IQR0，9]与BIS组8天[IQR0，13]；p=0.04)。
结论：BIS引导的深度镇静并没有改善DFCF天数，但减少了镇静药物的使用。需要镇静超过24小时的患者，它显示了DFCF天数的改善。
目的：BIS引导的深度镇静（RASS-4，-5）能否减少镇静剂量并增加无谵妄和无昏迷（DFCF）的天数？
方法：在三级混合ICU进行了一项随机对照试验，招募需要深度镇静>8小时的患者。患者被随机分配到临床评估（CA）或BIS组（BIS范围为40-60）。两组均使用BIS传感器,而CA组的屏幕保持覆盖。深度镇静后,拆卸BIS传感器,研究人员对随机分组不知情,每天两次评估谵妄.主要结果是深度镇静后14天内的DFCF天数。此外,我们比较了深度镇静期间镇静药物的剂量和BIS值.
结果：九十九名患者被纳入研究。我们发现CA和BIS臂之间的DFCF没有显着差异（p=0.1），但BIS组的异丙酚剂量明显较低（CA组1.77mg/kg/hr[95％CI1.60，1.93]vs.BIS组1.44mg/kg/hr[95%CI1.04,1.83];p=0.03)。在深度镇静期间，CA组花费的总时间为46％（95％CI35，57％），BIS值低于40，而BIS组花费的时间为32％（95％CI25，40％），（p=0.03）。针对镇静超过24小时的患者的亚组分析显示，BIS组的DFCF增加（CA组中位数为1天[IQR0，9]与BIS组8天[IQR0，13]；p=0.04)。
结论：BIS引导的深度镇静并没有改善DFCF天数，但减少了镇静药物的使用。需要镇静超过24小时的患者，它显示了DFCF天数的改善。
