Affiliation:
1. Department of Intensive Care Centre Hospitalier Universitaire Vaudois (CHUV)‐Lausanne University Hospital and University of Lausanne Lausanne Switzerland
2. Institute of Higher Education and Research in Healthcare CHUV‐Lausanne University Hospital and University of Lausanne Lausanne Switzerland
3. Medical Directorate for Research, Education and Innovation CHUV‐Lausanne University Hospital and University of Lausanne Lausanne Switzerland
Abstract
AbstractBackgroundDeep sedation may be indicated in the intensive care unit (ICU) for the management of acute organ failure, but leads to sedative‐induced delirium. Whether processed electroencephalography (p‐EEG) is useful in this setting is unclear.MethodsWe conducted a single‐centre observational study of non‐neurological ICU patients sedated according to a standardized guideline of deep sedation (Richmond Agitation Sedation Scale [RASS] between −5 and −4) during the acute phase of respiratory and/or cardio‐circulatory failure. The SedLine (Masimo Incorporated, Irvine, California) was used to monitor the Patient State Index (PSI) (ranging from 0 to 100, <25 = very deep sedation and >50 = light sedation to full awareness) during the first 72 h of care. Delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM‐ICU).ResultsThe median duration of PSI monitoring was 43 h. Patients spent 49% in median of the total PSI monitoring duration with a PSI <25. Patients with delirium (n = 41/97, 42%) spent a higher percentage of total monitored time with PSI <25 (median 67% [19–91] vs. 47% [12.2–78.9]) in non‐delirious patients (p .047). After adjusting for the cumulative dose of analgesia and sedation, increased time spent with PSI <25 was associated with higher delirium (odds ratio 1.014; 95% CI 1.001–1.027, p = .036).ConclusionsA clinical protocol of deep sedation targeted to RASS at the acute ICU phase may be associated with prolonged EEG suppression and increased delirium. Whether PSI‐targeted sedation may help reducing sedative dose and delirium deserves further clinical investigation.Relevance to Clinical PracticePatients requiring deep sedation are at high risk of being over‐sedated and developing delirium despite the application of an evidence‐based sedation guideline. Development of early objective measures are essential to improve sedation management in these critically ill patients.