Electroencephalography spectral edge frequency and suppression rate-guided sedation in patients with COVID-19: A randomized controlled trial

Tobar, Eduardo; Farías, José; Rojas, Veronica; Penna, Antonello; EgaÑa, JosÉ Ignacio; Ponce, Daniela; Bravo, Daniela; Maldonado, Felipe; Gajardo, Abraham; Gutierrez, Rodrigo

Keywords: sedation, COVID-19, electroencephalogram, bispectral index, suppression rate, spectral edge frequency

Abstract

Background: Sedation in coronavirus disease 2019 (COVID-19) patients has been identified as a major challenge. We aimed to investigate whether the use of a multiparameter electroencephalogram (EEG) protocol to guide sedation in COVID-19 patients would increase the 30-day mechanical ventilation-free days (VFD). Methods: We conducted a double-blind randomized clinical trial. We included patients with severe pneumonia due to COVID-19 who required mechanical ventilation (MV) and deep sedation. We randomized to the control (n = 25) or multiparameter group (n = 25). Sedation in the intervention group was administered following the standard institutional protocols together with a flow chart designed to reduce the propofol administration dose if the EEG suppression rate was over 2% or the spectral edge frequency 95 (SEF95) was below 10 Hz. We performed an intention-to-treat analysis to evaluate our primary outcome (30-day VFD). Results: There was no difference in VFD at day 30 (median: 11 [IQR 0–20] days in the control group vs. 0 [IQR 0–21] days in the BIS multiparameter group, p = 0.87). Among secondary outcomes, we documented a 17% reduction in the total adjusted propofol administered during the first 5 days of the protocol [median: 2.3 (IQR 1.9–2.8) mg/k/h in the control group vs. 1.9(IQR 1.5–2.2) mg/k/h in the MP group, p = 0.005]. This was accompanied by a higher average BIS value in the intervention group throughout the treatment period. Conclusion: A sedation protocol guided by multivariate EEG-derived parameters did not increase the 30-day VFD. However, the intervention led to a reduction in total propofol administration.

Más información

Título de la Revista: FRONTIERS IN MEDICINE
Editorial: FRONTIERS MEDIA SA
Fecha de publicación: 2022
Idioma: Ingles
Financiamiento/Sponsor: This study was funded by the Agencia Nacional de Investigación y Desarrollo (ANID), Ministerio de Ciencia y Tecnología, Gobierno de Chile (ANID COVID Grant Number 349).
URL: https://www.frontiersin.org/articles/10.3389/fmed.2022.1013430/full?amp;amp
DOI:

https://doi.org/10.3389/fmed.2022.1013430