1. Feasibility of continuous sedation monitoring in critically ill intensive care unit patients using the NeuroSENSE WAV CNS index.
- Author
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West N, McBeth PB, Brodie SM, van Heusden K, Sunderland S, Dumont GA, Griesdale DEG, Ansermino JM, and Görges M
- Subjects
- Conscious Sedation statistics & numerical data, Critical Care, Deep Sedation statistics & numerical data, Electroencephalography instrumentation, Electroencephalography statistics & numerical data, Feasibility Studies, Female, Humans, Hypnotics and Sedatives administration & dosage, Intensive Care Units, Male, Middle Aged, Monitoring, Physiologic instrumentation, Monitoring, Physiologic statistics & numerical data, Pilot Projects, Propofol administration & dosage, Conscious Sedation methods, Consciousness Monitors statistics & numerical data, Deep Sedation methods, Electroencephalography methods, Monitoring, Physiologic methods
- Abstract
Sedation in the intensive care unit (ICU) is challenging, as both over- and under-sedation are detrimental. Current methods of assessment, such as the Richmond Agitation Sedation Scale (RASS), are measured intermittently and rely on patients' behavioral response to stimulation, which may interrupt sleep/rest. A non-stimulating method for continuous sedation monitoring may be beneficial and allow more frequent assessment. Processed electroencephalography (EEG) monitors have not been routinely adopted in the ICU. The aim of this observational study was to assess the feasibility of using the NeuroSENSE™ monitor for EEG-based continuous sedation assessment. With ethical approval, ICU patients on continuous propofol sedation were recruited. Depth-of-hypnosis index (WAV
CNS ) values were obtained from the NeuroSENSE. Bedside nurses, blinded to the NeuroSENSE, performed regular RASS assessments and maintained the sedation regimen as per standard of care. Participants were monitored throughout the duration of their propofol infusion, up to 24 h. Fifteen patients, with median [interquartile range] age of 57 [52-62.5] years were each monitored for a duration of 9.0 [5.7-20.1] h. Valid WAVCNS values were obtained for 89% [66-99] of monitoring time and were widely distributed within and between individuals, with 6% [1-31] spent < 40 (very deep), and 3% [1-15] spent > 90 (awake). Significant EEG suppression was detected in 3/15 (20%) participants. Observed RASS matched RASS goals in 36/89 (40%) assessments. The WAVCNS variability, and incidence of EEG suppression, highlight the limitations of using RASS as a standalone sedation measure, and suggests potential benefit of adjunct continuous brain monitoring.- Published
- 2018
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