Comparison of Quantium Consciousness Index and Richmond Agitation Sedation Scale in Mechanically Ventilated Critically Ill Patients: An Observational Study
Makam S Harsha, Priyanka Sethi
Intensive care unit (ICU), Quantium consciousness index (qCON), Richmond agitation sedation scale (RASS), Sedation
Citation Information :
Harsha MS, Sethi P. Comparison of Quantium Consciousness Index and Richmond Agitation Sedation Scale in Mechanically Ventilated Critically Ill Patients: An Observational Study. Indian J Crit Care Med 2022; 26 (4):493-497.
Background: The quantium consciousness index (qCON), an electroencephalography (EEG)-based modality, has no studies regarding intensive care unit (ICU) sedation, though very few studies describe its use for assessing depth of anesthesia in the operation theater. In this study, we evaluated qCON for assessing sedation compared with Richmond Agitation Sedation Scale (RASS) in patients on a mechanical ventilator in the ICU.
Materials and methods: Eighty-seven mechanically ventilated patients aged between 18 and 60 years were investigated over a 12-hour period. They were given a standardized dosage of sedation comprised of a bolus dose of propofol 0.5 mg/kg and fentanyl 1 µg/kg, and then infusions of propofol 2–5 mg/kg/hour and fentanyl 0.5–2 µg/kg/hour. These drug infusions were adjusted to achieve a RASS score between 0 and -3. Using the qCON monitor, the investigator recorded the qCON values and then assessed the RASS score.
Results: A total of 1,218 readings were obtained. After contrasting each qCON value correspondingly with time to each RASS value, we found their correlation to be statistically significant (ρ = 0.288, p <0.0001). With the help of receiver operating characteristic (ROC) curves, we were able to differentiate appropriate from inappropriate levels of sedation. A qCON value of 80 had a sensitivity of 72.67% and a specificity of 67.42% (AUC 0.738 with SE 0.021).
Conclusion: qCON can be used for assessing sedation levels in mechanically ventilated critically ill patients.
Clinical trial registration: CTRI/2019/07/020064.
Chawla R, Myatra SN, Ramakrishnan N, Todi S, Kansal S, Dash SK. Current practices of mobilization, analgesia, relaxants and sedation in Indian ICUs: a survey conducted by the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2014;18:575–584. DOI: 10.4103/0972-5229.140146.
De Backer D, Norrenberg M. Let's change our behaviors: From bed rest and heavy sedation to awake, spontaneously breathing and early mobilized Intensive Care Unit patients. Indian J Crit Care Med 2014;18:558–559. DOI: 10.4103/0972-5229.140137.
Chen TJ, Chung YW, Chen PY, Hu SH, Chang CC, Hsieh SH, et al. Effects of daily sedation interruption in intensive care unit patients undergoing mechanical ventilation: a meta-analysis of randomized controlled trials. Int J Nurs Pract 2021:e12948. DOI: 10.1111/ijn.12948.
Candiotti KA, Gan TJ, Young C, Bekker A, Sum-Ping ST, Kahn R, et al. A randomized, open-label study of the safety and tolerability of fospropofol for patients requiring intubation and mechanical ventilation in the intensive care unit. Anesth Analg 2011;113:550–556. DOI: 10.1213/ANE.0b013e31821d7faf.
Namigar T, Serap K, Esra AT, Özgül O, Can ÖA, Aysel A, et al. The correlation among the Ramsay sedation scale, Richmond agitation sedation scale and Riker sedation agitation scale during midazolam-remifentanil sedation. Rev Bras Anestesiol 2017;67:347–354. DOI: 10.1016/j.bjan.2017.03.006.
Weeden M, Desai N, Sriram S, Swami Palaniswami M, Wang B, Talbot L, et al. A pilot study of high frequency accelerometry-based sedation and agitation monitoring in critically ill patients. Crit Care Resusc 2020;22(3):245–252. PMID: 32900331.
Pappal RD, Roberts BW, Winkler W, Yaegar LH, Stephens RJ, Fuller BM. Awareness and bispectral index (BIS) monitoring in mechanically ventilated patients in the emergency department and intensive care unit: a systematic review protocol. BMJ Open 2020;10:e034673. DOI: 10.1136/bmjopen-2019-034673.
Sanavia E, García M, Del Castillo J, González R, López-Herce J, Mencía S. Effect of neuromuscular blockade on the bispectral index in critically ill patients. An Pediatr (Barc) 2020;93:251–256. DOI: 10.1016/j.anpedi.2019.07.010.
Linassi F, Kreuzer M, Maran E, Farnia A, Zanatta P, Navalesi P, et al. Age influences on Propofol estimated brain concentration and entropy during maintenance and at return of consciousness during total intravenous anesthesia with target-controlled infusion in unparalyzed patients: an observational prospective trial. PLoS One 2020;15:e0244145. DOI: 10.1371/journal.pone.0244145.
Puchner WF, Dünser MW, Paulus P, Neuner MP, Mayer CL, Pomberger IM, et al. A comparative study on adequate anesthesia depth: clinical judgement and the Narcotrend® measurement. Can J Anaesth 2020;67:664–673. DOI: 10.1007/s12630-020-01602-x.
Melia U, Gabarron E, Agustí M, Souto N, Pineda P, Fontanet J, et al. Comparison of the qCON and qNOX indices for the assessment of unconsciousness level and noxious stimulation response during surgery. J Clin Monit Comput 2017;31:1273–1281. DOI: 10.1007/s10877-016-9948-z.
Zanner R, Schneider G, Meyer A, Kochs E, Kreuzer M. Time delay of the qCON monitor and its performance during state transitions. J Clin Monit Comput 2021;35:379–386. DOI: 10.1007/s10877-020-00480-4.
Jensen EW, Valencia JF, López A, Anglada T, Agustí M, Ramos Y, et al. Monitoring hypnotic effect and nociception with two EEG-derived indices, qCON and qNOX, during general anaesthesia. Acta Anaesthesiol Scand 2014;58:933–941. DOI: 10.1111/aas.12359.
Christenson C, Martinez-Vazquez P, Breidenstein M, Farhang B, Mathews J, Melia U, et al. Comparison of the Conox (qCON) and Sedline (PSI) depth of anaesthesia indices to predict the hypnotic effect during desflurane general anaesthesia with ketamine. J Clin Monit Comput. 2020. DOI: 10.1007/s10877-020-00619-3.
Sharma A, Singh PM, Trikha A, Rewari V, Chandralekha. Entropy correlates with Richmond agitation sedation scale in mechanically ventilated critically ill patients. J Clin Monit Comput 2014;28:193–201. DOI: 10.1007/s10877-013-9517-7.
Müller JN, Kreuzer M, García PS, Schneider G, Hautmann H. Monitoring depth of sedation: evaluating the agreement between the Bispectral Index, qCON and the Entropy Module's State Entropy during flexible bronchoscopy. Minerva Anestesiol 2017;83:563–573. DOI: 10.23736/S0375-9393.17.11262-9.
Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 2013;41:263–306. DOI: 10.1097/CCM.0b013e3182783b72.
Kress JP, Pohlman AS, O'Connor MF, Hall JB. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 2000;342:1471–1477. DOI: 10.1056/NEJM200005183422002.
Rozendaal FW, Spronk PE, Snellen FF, Schoen A, van Zanten AR, Foudraine NA, et al. Remifentanil-propofol analgo-sedation shortens duration of ventilation and length of ICU stay compared to a conventional regimen: a centre randomised, cross-over, open-label study in the Netherlands. Intensive Care Med 2009;35:291–298. DOI: 10.1007/s00134-008-1328-9.