Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS
The sedation management of patients with severe COVID-19 is challenging. Processed electroencephalography (pEEG) has already been used for sedation management before COVID-19 in critical care, but its applicability in COVID-19 has not yet been investigated. We performed this prospective observationa...
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MDPI AG
2022-06-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/12/3494 |
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| author | Armin Niklas Flinspach Sebastian Zinn Kai Zacharowski Ümniye Balaban Eva Herrmann Elisabeth Hannah Adam |
| author_facet | Armin Niklas Flinspach Sebastian Zinn Kai Zacharowski Ümniye Balaban Eva Herrmann Elisabeth Hannah Adam |
| author_sort | Armin Niklas Flinspach |
| collection | DOAJ |
| description | The sedation management of patients with severe COVID-19 is challenging. Processed electroencephalography (pEEG) has already been used for sedation management before COVID-19 in critical care, but its applicability in COVID-19 has not yet been investigated. We performed this prospective observational study to evaluate whether the patient sedation index (PSI) obtained via pEEG may adequately reflect sedation in ventilated COVID-19 patients. Statistical analysis was performed by linear regression analysis with mixed effects. We included data from 49 consecutive patients. None of the patients received neuromuscular blocking agents by the time of the measurement. The mean value of the PSI was 20 (±23). The suppression rate was determined to be 14% (±24%). A deep sedation equivalent to the Richmond Agitation and Sedation Scale of −3 to −4 (correlation expected PSI 25–50) in bedside examination was noted in 79.4% of the recordings. Linear regression analysis revealed a significant correlation between the sedative dosages of propofol, midazolam, clonidine, and sufentanil (<i>p</i> < 0.01) and the sedation index. Our results showed a distinct discrepancy between the RASS and the determined PSI. However, it remains unclear to what extent any discrepancy is due to the electrophysiological effects of neuroinflammation in terms of pEEG alteration, to the misinterpretation of spinal or vegetative reflexes during bedside evaluation, or to other causes. |
| first_indexed | 2024-03-09T23:25:56Z |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T23:25:56Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-02ea2270ac1f4530acfd049a9019a19f2023-11-23T17:17:05ZengMDPI AGJournal of Clinical Medicine2077-03832022-06-011112349410.3390/jcm11123494Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDSArmin Niklas Flinspach0Sebastian Zinn1Kai Zacharowski2Ümniye Balaban3Eva Herrmann4Elisabeth Hannah Adam5Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, GermanyDepartment of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, GermanyDepartment of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, GermanyDepartment of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, GermanyDepartment of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, GermanyDepartment of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, GermanyThe sedation management of patients with severe COVID-19 is challenging. Processed electroencephalography (pEEG) has already been used for sedation management before COVID-19 in critical care, but its applicability in COVID-19 has not yet been investigated. We performed this prospective observational study to evaluate whether the patient sedation index (PSI) obtained via pEEG may adequately reflect sedation in ventilated COVID-19 patients. Statistical analysis was performed by linear regression analysis with mixed effects. We included data from 49 consecutive patients. None of the patients received neuromuscular blocking agents by the time of the measurement. The mean value of the PSI was 20 (±23). The suppression rate was determined to be 14% (±24%). A deep sedation equivalent to the Richmond Agitation and Sedation Scale of −3 to −4 (correlation expected PSI 25–50) in bedside examination was noted in 79.4% of the recordings. Linear regression analysis revealed a significant correlation between the sedative dosages of propofol, midazolam, clonidine, and sufentanil (<i>p</i> < 0.01) and the sedation index. Our results showed a distinct discrepancy between the RASS and the determined PSI. However, it remains unclear to what extent any discrepancy is due to the electrophysiological effects of neuroinflammation in terms of pEEG alteration, to the misinterpretation of spinal or vegetative reflexes during bedside evaluation, or to other causes.https://www.mdpi.com/2077-0383/11/12/3494critical carehypnotics and sedativesacute respiratory distress syndromesevere acute respiratory syndrome coronavirus 2electroencephalogramindex of consciousness-view monitor |
| spellingShingle | Armin Niklas Flinspach Sebastian Zinn Kai Zacharowski Ümniye Balaban Eva Herrmann Elisabeth Hannah Adam Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS Journal of Clinical Medicine critical care hypnotics and sedatives acute respiratory distress syndrome severe acute respiratory syndrome coronavirus 2 electroencephalogram index of consciousness-view monitor |
| title | Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS |
| title_full | Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS |
| title_fullStr | Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS |
| title_full_unstemmed | Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS |
| title_short | Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS |
| title_sort | electroencephalogram based evaluation of impaired sedation in patients with moderate to severe covid 19 ards |
| topic | critical care hypnotics and sedatives acute respiratory distress syndrome severe acute respiratory syndrome coronavirus 2 electroencephalogram index of consciousness-view monitor |
| url | https://www.mdpi.com/2077-0383/11/12/3494 |
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