Association Between Clinical Measures of Depth of Sedation and Multimodal Cerebral Physiology in Acute Traumatic Neural Injury.

IF 1.8 Q3 CLINICAL NEUROLOGY
Neurotrauma reports Pub Date : 2024-10-02 eCollection Date: 2024-01-01 DOI:10.1089/neur.2024.0090
Kangyun Park, Logan Froese, Tobias Bergmann, Alwyn Gomez, Amanjyot Singh Sainbhi, Nuray Vakitbilir, Abrar Islam, Kevin Y Stein, Izzy Marquez, Fiorella Amenta, Younis Ibrahim, Frederick A Zeiler
{"title":"Association Between Clinical Measures of Depth of Sedation and Multimodal Cerebral Physiology in Acute Traumatic Neural Injury.","authors":"Kangyun Park, Logan Froese, Tobias Bergmann, Alwyn Gomez, Amanjyot Singh Sainbhi, Nuray Vakitbilir, Abrar Islam, Kevin Y Stein, Izzy Marquez, Fiorella Amenta, Younis Ibrahim, Frederick A Zeiler","doi":"10.1089/neur.2024.0090","DOIUrl":null,"url":null,"abstract":"<p><p>Neurointensive care primarily focuses on secondary injury reduction, utilizing a variety of guideline-based approaches (including administration of high-dose sedation) to reduce the injured state. However, titration of sedation is currently based on the Richmond Agitation Sedation Scale (RASS), a subjective clinical grading score of a patient's response to external physical stimuli, and not an objective measure. Therefore, it is likely that there exists substantial variation in objective sedation depth for a given clinical grade in these patients, leading to undesired sedation depths and cerebral physiological consequences. Improper sedation can impede cerebral autoregulation, emphasizing the critical need for optimal sedation in traumatic brain injury (TBI) patients. This study evaluates the relationship between RASS to an objective measure of depth of sedation (bispectral index, BIS) and cerebral physiological measures. Fifty-nine patients were assessed using Jonckheere-Terpstra testing to compare various key physiologies with RASS. RASS (-5 through 0 categories) showed no statistically significant relationship between BIS and cerebral physiological parameters, after adjusting for multiple comparisons. Furthermore, it is crucial to note that within each RASS value, the distribution of the physiological measures all had high variability. As an exemplar, for RASS values of -5 and -4, BIS ranged from near 0 (burst suppression levels) up to over 80 (near awake states). BIS and other cerebral physiologies displayed substantial variation across each RASS category. This suggests that RASS as a means to titrate sedative medication for the goal of neuroprotection is insufficient. More momentary, individualized determination of sedation depth is required for TBI patients.</p>","PeriodicalId":74300,"journal":{"name":"Neurotrauma reports","volume":null,"pages":null},"PeriodicalIF":1.8000,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11513567/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurotrauma reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1089/neur.2024.0090","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Neurointensive care primarily focuses on secondary injury reduction, utilizing a variety of guideline-based approaches (including administration of high-dose sedation) to reduce the injured state. However, titration of sedation is currently based on the Richmond Agitation Sedation Scale (RASS), a subjective clinical grading score of a patient's response to external physical stimuli, and not an objective measure. Therefore, it is likely that there exists substantial variation in objective sedation depth for a given clinical grade in these patients, leading to undesired sedation depths and cerebral physiological consequences. Improper sedation can impede cerebral autoregulation, emphasizing the critical need for optimal sedation in traumatic brain injury (TBI) patients. This study evaluates the relationship between RASS to an objective measure of depth of sedation (bispectral index, BIS) and cerebral physiological measures. Fifty-nine patients were assessed using Jonckheere-Terpstra testing to compare various key physiologies with RASS. RASS (-5 through 0 categories) showed no statistically significant relationship between BIS and cerebral physiological parameters, after adjusting for multiple comparisons. Furthermore, it is crucial to note that within each RASS value, the distribution of the physiological measures all had high variability. As an exemplar, for RASS values of -5 and -4, BIS ranged from near 0 (burst suppression levels) up to over 80 (near awake states). BIS and other cerebral physiologies displayed substantial variation across each RASS category. This suggests that RASS as a means to titrate sedative medication for the goal of neuroprotection is insufficient. More momentary, individualized determination of sedation depth is required for TBI patients.

急性创伤性神经损伤患者镇静深度的临床测量与多模态脑生理学之间的关系
神经重症监护主要侧重于减少二次损伤,利用各种基于指南的方法(包括使用大剂量镇静剂)来减轻损伤状态。然而,目前镇静剂的滴定是以里士满躁动镇静量表(RASS)为基础的,该量表是对患者对外部物理刺激反应的主观临床评分,而非客观测量。因此,在这些患者的特定临床分级中,客观镇静深度很可能存在很大差异,从而导致不理想的镇静深度和大脑生理后果。不适当的镇静会阻碍大脑的自动调节,这就强调了创伤性脑损伤(TBI)患者对最佳镇静的迫切需要。本研究评估了 RASS 与镇静深度的客观测量值(双谱指数,BIS)和脑生理测量值之间的关系。研究人员使用 Jonckheere-Terpstra 测试对 59 名患者进行了评估,以比较 RASS 与各种关键生理指标之间的关系。经多重比较调整后,RASS(-5 至 0 级)显示 BIS 与大脑生理参数之间没有统计学意义上的显著关系。此外,值得注意的是,在每个 RASS 值内,生理指标的分布都有很大的变异性。例如,当 RASS 值为 -5 和 -4 时,BIS 值从接近 0(爆发抑制水平)到超过 80(接近清醒状态)不等。在每个 RASS 类别中,BIS 和其他大脑生理指标都有很大差异。这表明,将 RASS 作为滴定镇静药物以达到神经保护目的的手段是不够的。对创伤性脑损伤患者而言,镇静深度的确定需要更加即时和个性化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
2.40
自引率
0.00%
发文量
0
审稿时长
8 weeks
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信