Ağır ARDS hastalarında sedasyon yönetiminde bispektral indeks ve rass skorlarının karşılaştırılması: mortalite üzerine etkileri

Year 2025, Volume: 16 Issue: 1, 167 - 172, 25.03.2025

Zerrin Özçelik , Yücel Gültekin

https://doi.org/10.18663/tjcl.1572663

Abstract

Amaç: Ağır akut respiratuvar distres sendromu (ARDS) hastalarında sedasyon yönetimi, yoğun bakım sonuçları üzerinde kritik bir rol oynamaktadır. Bispektral indeks (BİS) ve Richmond Ajitasyon ve Sedasyon Skalası (RASS), sedasyon düzeylerini belirlemede yaygın olarak kullanılan iki yöntemdir. Bu çalışmada, BİS ve RASS skorlarının karşılaştırılması ve bu skorların mortalite üzerindeki etkilerinin incelenmesi amaçlanmıştır.
Gereç ve Yöntemler: Bu retrospektif çalışmada, mekanik ventilasyon altındaki ağır ARDS tanısı almış 98 hasta değerlendirildi. BİS ve RASS skorları pron ve supin pozisyonlarında ölçüldü ve bu skorlar arasındaki korelasyon ile klinik parametreler analiz edildi. BİS ≤40 ve BİS >40 olmak üzere iki gruba ayrıldı ve mortalite açısından değerlendirildi.
Bulgular: BİS ve RASS skorları arasında hem supin (r=0.53, p<0.001) hem de pron (r=0.46, p<0.001) pozisyonlarında anlamlı ve orta dereceli bir korelasyon tespit edildi. BİS ≤40 ve BİS >40 grupları arasında mortalite oranları BİS ≤40 grubunda %88, BİS >40 grubunda %81.3 olarak belirlendi, ancak bu fark istatistiksel olarak anlamlı değildi (p=0.35).
Sonuç: BİS monitorizasyonu, ARDS hastalarında sedasyon yönetiminde değerli bir araç olmasına rağmen, sedasyon yönetiminde hem BİS hem de RASS skorlarının birlikte kullanılması daha doğru klinik sonuçlar elde edilmesine katkı sağlayabilir. BİS monitorizasyonu faydalı olmakla birlikte mortaliteye etkisi gösterilememiştir.

Keywords

Akut Respiratuvar Distres Sendromu, Bispektral İndeks, Sedasyon Skalası

Ethical Statement

Sancaktepe Prof Dr İlhan Varank Eğitim ve Araştırma Hastanesi Etik Kurulu E-46059653-020

Supporting Institution

yok

Comparison of bispectral index and rass scores in sedation management of patients with severe ards: effects on mortality

Abstract

Aim: Sedation management plays a critical role in the outcomes of patients with severe acute respiratory distress syndrome (ARDS). Bispectral index (BIS) and the Richmond Agitation-Sedation Scale (RASS) are two commonly used methods to assess sedation levels. This study aimed to compare BIS and RASS scores and evaluate the impact of these scores on mortality.
Materials and Methods: In this retrospective study, 98 patients diagnosed with severe ARDS and under mechanical ventilation were evaluated. BIS and RASS scores were measured in both prone and supine positions, and the correlation between these scores and clinical parameters was analyzed. Patients were divided into two groups: BIS ≤40 and BIS >40, and their mortality rates were assessed.
Results: A significant moderate correlation was found between BIS and RASS scores in both supine (r=0.53, p<0.001) and prone (r=0.46, p<0.001) positions. Mortality rates were 88% in the BIS ≤40 group and 81.3% in the BIS >40 group, but this difference was not statistically significant (p=0.35).
Conclusion: While BIS monitoring is a valuable tool in sedation management for ARDS patients, the combined use of BIS and RASS scores may contribute to more accurate clinical outcomes in sedation management. Although BIS monitoring is useful, its effect on mortality has not been demonstrated.

Keywords

Acute Respiratory Distress Syndrome, Bispectral Index, Sedation Scale

References

• Bocelli E, Fatah A, Ledochowki S. ANI and BIS variations in supine and prone position during closed-tracheal suction in sedated and myorelaxed ICU patients with severe COVID-19. J Clin Monit Comput 2021; 35: 1403-1409.
• Sessler CN, Gosnell MS, Grap MJ. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002; 166: 1338-44.
• Zorrilla-Vaca A, Healy RJ, Wu CL, Grant MC. Relation between bispectral index measurements of anesthetic depth and postoperative mortality. Can J Anaesth 2017; 64: 597-607.
• Lia E, Pucci V, Raccagna C, Sebastiani S, Samolsky Dekel BG. Analgosedation management in the intensive care unit: A narrative systematic review. The Open Anesthesia Journal 2023. https://doi.org/10.2174/0125896458275320231120071303
• Brochard L, Slutsky A, Pesenti A. Mechanical ventilation to minimize progression of lung injury in acute respiratory failure. Am J Respir Crit Care Med 2017; 195: 438-42.
• Yousefi H, Toghyani F, Yazdannik AR. Effect of using Richmond Agitation Sedation Scale on duration of mechanical ventilation, type, and dosage of sedation on hospitalized patients in intensive care units. Iran J Nurs Midwifery Res 2015; 20: 700-04.
• Chanques G, Constantin JM, Devlin JW, Ely EW, Fraser GL, Gélinas C, Girard TD, Guérin C, Jabaudon M, Jaber S, Mehta S, Langer T, Murray MJ, Pandharipande P, Patel B, Payen JF, Puntillo K, Rochwerg B, Shehabi Y, Strøm T, Olsen HT, Kress JP. Analgesia and sedation in patients with ARDS. Intensive Care Med. 2020 Dec;46(12):2342-2356. doi: 10.1007/s00134-020-06307-9. Epub 2020 Nov 10. PMID: 33170331; PMCID: PMC7653978.
• Ammar MA, Sacha GL, Welch SC, Bass SN, Kane-Gill SL, Duggal A, Ammar AA. Sedation, Analgesia, and Paralysis in COVID-19 Patients in the Setting of Drug Shortages. J Intensive Care Med. 2021 Feb;36(2):157-174. doi: 10.1177/0885066620951426. Epub 2020 Aug 26. PMID: 32844730.
• Prottengeier J, Moritz A, Heinrich S. Sedation assessment in a mobile intensive care unit: a prospective pilot study on the relation of clinical sedation scales and the bispectral index. Crit Care 2014; 18: 615.
• Jung YJ, Chung WY, Lee M. The significance of sedation control in patients receiving mechanical ventilation. Tuberc Respir Dis (Seoul) 2012; 73: 151-61.
• Yaman F, Ozcan N, Ozcan A, et al. Assessment of correlation between bispectral index and four common sedation scales used in mechanically ventilated patients in ICU. Eur Rev Med Pharmacol Sci 2012; 16: 660-66.
• Karamchandani K, Rewari V, Trikha A. Bispectral index correlates well with Richmond agitation sedation scale in mechanically ventilated critically ill patients. J Anesth 2010; 24: 394-98.
• Sonneville R, Verdonk F, Rauturier C. Understanding brain dysfunction in sepsis. Ann Intensive Care 2013; 3: 15.
• Gofton TE, Young GB. Sepsis-associated encephalopathy. Nat Rev Neurol 2012; 557-66.
• Heavner MS, Gorman EF, Linn DD, Yeung SYA, Miano TA. Systematic review and meta-analysis of the correlation between bispectral index (BIS) and clinical sedation scales: Toward defining the role of BIS in critically ill patients. Pharmacotherapy 2022; 42: 667-76. https://doi.org/10.1002/phar.2712
• Vivien B, Langeron O, Riou B. Increase in bispectral index while correcting a severe hypoglycemia. Anesth Analg 2002; 95: 1824-25.
• Duarte LTD, Saraiva RA. When the bispectral index can give false results. Rev Bras Anestesiol 2009; 59: 99-109.
• Koitabashi T, Johansen JW, Sebel PS. Remifentanil dose/electroencephalogram bispectral response during combined propofol/regional anesthesia. Anesth Analg 2002; 94: 150-53.
• Lysakowski C, Dumont L, Pellegrini M, Clergue F, Tassonyi E. Effects of fentanyl, alfentanil, remifentanil, and sulfentanil on loss of consciousness and bispectral index during propofol induction of anesthesia. Br J Anaesth 2001; 86: 523-27.
• Bass S, Vance ML, Reddy A. Bispectral index for titrating sedation in ARDS patients during neuromuscular blockade. Am J Crit Care 2019; 28: 377-84.
• Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA.
• Matthay MA, Arabi Y, Arroliga AC, Bernard G, Bersten AD, et al. A New Global Definition of Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2024 Jan 1;209(1):37-47.