Información del artículo
Resumen
La correcta monitorización de la analgesia y la sedación debe ser uno de los objetivos principales en las Unidades de Cuidados Intensivos. Una vez asegurada la analgesia, la correcta dosificación de los sedantes va a depender de la monitorización correcta del nivel de sedación. Desde hace años se han utilizado sistemas de monitorización basados en escalas. Estas escalas son adecuadas para la monitorización de la sedación superficial, pero no son capaces de evaluar el grado de sedación en pacientes profundamente sedados o con bloqueantes neuromusculares en perfusión continua. Actualmente disponemos de diferentes sistemas de monitorización que nos facilitan llegar donde las escalas no alcanzan. En este capítulo revisaremos el monitor más empleado en la actualidad en las Unidades de Cuidados Intensivos, y el recomendado por el grupo de trabajo de Sedación y Analgesia de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) para la monitorización de la sedación profunda, el Monitor BIS®.
Palabras clave:
BIS
Índice biespectral
Sedación
Sedantes
Paciente crítico
Monitorización
Abstract
Adequate monitoring of analgesia and sedation should be one of the main goals in the Intensive Care Units. Once the analgesia is assured, the correct dosage of the sedatives will depend on the correct monitoring of the sedation level. For years, clinical scales have been used to evaluate the sedation level. These scales are appropriate for the evaluation of mild sedation but they cannot correctly evaluate deeply sedated patients or those patients who require continuous intravenous administration of neuromuscular blockade agents. In this chapter, we review the most used monitor to control the adequate level of sedation in the Intensive Care Units as well as the BIS® Monitor, which is the one recommended by the Analgesia and Sedation Work Group of the Spanish Society of Critical Care Medicine (SEMICYUC).
Keywords:
BIS
Bispectral index
Sedation
Sedatives
Critical patient
Monitoring
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Bibliografía
[1.]
C. Wong, L. Burry, S. Molino-Carmona, M. Leo, J. Tessler, P. Hynes, et al.
Analgesic and sedative pharmacology in the intensive care unit.
Dynamics, 15 (2004), pp. 23-26
[2.]
S.A. Nasraway Jr, J. Jacobi, M.J. Murray, P.D. Lumb.
Sedation, analgesia and neuromuscular blockade of the critically ill adult: revised clinical practice guidelines for 2002.
Crit Care Med, 30 (2002), pp. 117-118
[4.]
C. Young, N. Knudsen, A. Hilton, J.C. Reves.
Sedation in the Intensive Care Unit.
Crit Care Med, 28 (2000), pp. 854-866
[5.]
C. Chamorro, M.A. Romera, J.A. Silva.
La importancia de la sedoanalgesia en los pacientes ventilados mecánicamente.
Med Intensiva, Suppl 1 (2003), pp. 2-4
[6.]
J. Barr, A. Donner.
Optimal intravenous dosing strategies for sedatives and analgesics in the intensive care unit.
Crit Care Clin, 11 (1995), pp. 827-847
[7.]
E. Mondello, R. Siliotti, E. Gravino, F. Coluzzi, T. David, A.U. Sinardi.
Sedation monitoring in ICU.
Minerva Anestesiol, 71 (2005), pp. 487-496
[8.]
O.L. Cremer, K.G. Moons, E.A. Bouman, J.E. Kruijswijk, A.M. de Smet, C.J. Kalkman.
Long-term propofol infusion and cardiac failure in adult head-injured patients.
Lancet, 357 (2001), pp. 117-118
[9.]
R.R. Riker, G.L. Fraser.
Adverse events associated with sedatives, analgesics, and other drugs that provide patient comfort in the intensive care unit.
Pharmacotherapy, 25 (2005), pp. 8S-18S
[10.]
J.C. Woods, L.C. Mion, J.T. Connor, F. Viray, L. Jahan, C. Huber, et al.
Severe agitation among ventilated medical intensive care unit patients: frecuency, characteristics and outcomes.
Intensive Care Med, 30 (2004), pp. 1066-1072
[12.]
P. Hynes-Gay, M. Leo, S. Molino-Carmona, J. Tessler, C. Wong, L. Burry, et al.
Optimizing sedation and analgesia in mechanically ventilated patients —on evidence-based approach.
Dynamics, 14 (2003), pp. 10-13
[13.]
G. Carrasco.
Instruments for monitoring intensive care unit sedation.
Crit Care, 4 (2000), pp. 217-225
[14.]
B.D. Watson, S.L. Kane-Gill.
Sedation assessment in critically ill adults: 2001-2004 update.
Ann Pharmacother, 38 (2004), pp. 2898-2906
[15.]
M. Ramsay, T.M. Savege, B.R. Simpson, R. Goodwin.
Controlled sedation with alphaxalone-alphadolone.
BMJ, 22 (1974), pp. 656-659
[16.]
C.N. Sessler, M.S. Gosnell, M.J. Grap, G.M. Brophy, P.V. O’Neal, K.A. Keane, et al.
The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients.
Am J Respir Crit Care Med, 166 (2002), pp. 1338-1344
[17.]
T.S. Walsh, P. Ramsay, R. Kinnunen.
Monitoring sedation in the intensive care unit: can “black boxes” help us?.
Intensive Care Med, 30 (2004), pp. 1511-1513
[18.]
C. Chamorro, J.L. Martínez-Melgar, R. Barrientos.
Grupo de Trabajo de Analgesia y Sedación de la SEMICYUC. Monitorización de la Sedación.
Med Intensiva, 32 (2008), pp. 45-52
[19.]
G.L. Fraser, R.R. Riker.
Bispectral Index monitoring in the intensive care unit provides more signal than noise.
Pharmacotherapy, 25 (2005), pp. 19S-27S
[20.]
J.W. Johansen, P.S. Sebel.
Development and clinical application of electroencephalographic bispectrum monitoring.
Anesthesiology, 93 (2000), pp. 1336-1344
[21.]
T. Shiraishi, H. Uchino, T. Sagara, N. Ishii.
A comparison of frontal and occipital bispectral index values obtained during neurosurgical procedures.
Anesth Analg, 98 (2004), pp. 1773-1775
[22.]
R. Arbour.
Continuous nervous system monitoring, EEG, the bispectral index, and neuromuscular transmission.
AACN Clin Issues, 14 (2003), pp. 185-207
[23.]
B. Vivien, S. Di Maria, A. Ouattara, O. Longeron, P. Coriat, B. Riou.
Overestimation of Bispectral Index in sedated intensive care unit patients revealed by administration of muscle relaxant.
Anesthesiology, 99 (2003), pp. 9-17
[24.]
M.K. Bader, R. Arbour, S. Palmer.
Refractory increased intracranial pressure in severe traumatic brain injury: barbiturate coma and bispectral index monitoring.
AACN Clin Issues, 16 (2005), pp. 526-541
[25.]
B.K. Wagner, K.E. Zavotsky, J.B. Sweeney, B.A. Palmer, J.S. Hammond.
Patient recall of therapeutic paralysis in a surgical critical care unit.
Pharmacotherapy, 18 (1998), pp. 358-363
[26.]
B.C. Weldon, M.E. Mahla, M.T. Van der Aa, T.G. Monk.
Advancing age and beeper intraoperative anesthetic levels are associated with higher first year death rates.
Anesthesiology, 96 (2002), pp. A1097
[27.]
C. Lennmarken, M.L. Lindholm, S.D. Greenwald, R. Sandin.
Confirmation that low intraoperative BIS levels predict increased risk of post-operative mortality.
Anesthesiology, 99 (2003), pp. A303
[28.]
T.G. Monk, V. Saini, B.C. Weldon, J.C. Sigl.
Anesthetic management and one-year mortality after noncardiac surgery.
Anesth Analg, 100 (2005), pp. 4-10
[29.]
M.L. Lindholm, S. Träff, F. Granath, S.D. Greenwald, A. Ekbom, C. Lennmarken, et al.
Mortality within 2 years after surgery in relation to low intraoperative bispectral index values and preexisting malignant disease.
Anesth Analg, 108 (2009), pp. 508-512
[30.]
P.L. Watson, A.K. Shintani, R. Tyson, P.P. Pandharipande, B.T. Pun, E.W. Ely.
Presence of electroencephalogram burst suppression in sedated, critically ill patients is associated with increased mortality.
Crit Care Med, 36 (2008), pp. 3171-3177
[31.]
A. Deogaonkar, R. Gupta, M. DeGeorgia, V. Sabharwal, B. Gopakumaran, A. Schubert, et al.
Bispectral index monitoring correlates with sedation scales in brain-injured patients.
Crit Care Med, 32 (2004), pp. 2403-2406
[32.]
Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS, Bratton SL, Chestnut RM, Ghajar J, McConnell Hammond FF, Harris OA, Hartl R, et al. Guidelines for the management of severe traumatic brain injury. XI Anesthetics, Analgesics, and Sedatives. J Neurotrauma. 2007;24Suppl1;S1:S71-6.
[33.]
J. Márquez, C. Chamorro, M.A. Romera, J.A. Silva.
Control del coma barbitúrico.
Med Intensiva, 27 (2003), pp. 252
[34.]
P. Jaggi, M.J. Schwabe, K. Gill, I.N. Horowitz.
Use of an anesthesia cerebral monitor biespectral index to assess burst suppression in pentobarbital coma.
Pediatr Neurol, 28 (2003), pp. 219-222
[35.]
R.R. Riker, G.L. Fraser, M.L. Wilkins.
Comparing the biespectral index and suppression ratio with burst suppression of the electroencephalogram during pentobarbital infusions in adult intensive care patients.
Pharmacotherapy, 23 (2003), pp. 1087-1093
[36.]
C. Okuyaz, H. Birbicer, N. Doruk, A. Atici.
Bispectral index monitoring in confirmation of brain death in children.
J Child Neurol, 21 (2006), pp. 799-801
[37.]
B. Vivien, X. Paqueron, P. Le Cosquer, O. Langeron, P. Coriat, B. Riou.
Detection of brain death onset using the bispectral index in severely comatose patients.
Intensive Care Med, 28 (2002), pp. 419-425
[38.]
D. Escudero, J. Otero, G. Muñiz, D. Parra, L. Cofiño, J. Taboada.
Deteccion de muerte encefálica mediante monitorización BIS (índice biespectral).
Med Intensiva, 29 (2005), pp. 272-278
[39.]
R.E. Tallach, D.R. Ball, P. Jefferson.
Monitoring seizures with the bispectral index.
Anaesthesia, 59 (2004), pp. 1033-1034
[40.]
C. Chamorro, M.A. Romera, B. Balandín, M. Valdivia.
Nonconvulsive status and bispectral index.
Crit Care Med, 36 (2008), pp. 2218-2219
[41.]
N. Fàbregas, P.L. Gambús, R. Valero, E.J. Carrero, L. Salvador, E. Zavala, et al.
Can bispectral index monitoring predict recovery of consciousness in patients with severe brain injury?.
Anesthesiology, 101 (2004), pp. 43-51
[42.]
C. Pardo, T. Muñoz, C. Chamorro, Analgesia and Sedation Work Group of SEMICYUC.
Monitoring pain: recommendations of the Analgesia and Sedation Work Group of SEMICYUC.
Med Intensiva, 30 (2006), pp. 379-385
[43.]
S.D. Greenwald, C. Rosow.
BIS and EMG Variability Increase before Somatic Responses during Surgery.
Anesthesiology, 105 (2006), pp. A1027
[44.]
C. De Deyne, M. Struys, J. Decruyenaere, J. Creupelandt, E. Hoste, F. Colardyn.
Use of continuous bispectral EEG monitoring to assess depth of sedation in ICU patients.
Intensive Care Med, 24 (1998), pp. 1294-1298
[45.]
L.E. Simmons, R.R. Riker, B.S. Prato, G.L. Fraser.
Assessing sedation during intensive care unit mechanical ventilation with the Bispectral Index and the Sedation-Agitation Scale.
Crit Care Med, 27 (1999), pp. 1499-1504
[46.]
K. Hirota, T. Kubota, H. Ishihara, A. Matsuki.
The effects of nitrous oxide and ketamine on the biespectral index and 95% spectral edge frequency during propofol-fentanyl anaesthesia.
Eur J Anaesthesiol, 16 (1999), pp. 779-783
[47.]
D. Frenzel, C.A. Greim, C. Sommer, K. Bauerle, N. Roewer.
Is the bispectral index appropriate for monitoring the sedation level of mechanically ventilated surgical ICU patients?.
Intensive Care Med, 28 (2002), pp. 178-183
[48.]
P.H. Tonner, C. Wei, B. Bein, N. Weiler, A. Paris, J. Scholz.
Comparison of two bispectral index algorithms in monitoring sedation in postoperative care patients.
Crit Care Med, 33 (2005), pp. 580-584
[49.]
S.A. Nasraway Jr.
The Bispectral Index: expanded performance for everyday use in the intensive care unit?.
Crit Care Med, 33 (2005), pp. 685-687
[50.]
M.L. Riess, U.A. Graefe, C. Goeters, H. Van Aken, H.G. Bone.
Sedation assessment in critically ill patients with bispectral index.
Eur J Anaesthesiol, 19 (2002), pp. 18-22
[51.]
R.R. Riker, G.L. Fraser.
Sedation in the intensive care unit: refining the models and defining the questions.
Crit Care Med, 30 (2002), pp. 1661-1663
[52.]
S. Inoue, M. Kawaguchi, N. Sasaoka, K. Hirai, H. Furuya.
Effects of neuromuscular block on systemic and cerebral hemodynamics and bispectral index during moderate or deep sedation in critically ill patients.
Intensive Care Med, 32 (2006), pp. 391-397
[53.]
R. Arbour.
Impact of bispectral index monitoring on sedation and outcomes in critically ill adults: a case series.
Crit Care Nurs Clin North Am, 18 (2006), pp. 227-241
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