title: A rational approach to the control of sedation in intensive care unit patients based on closed-loop control.
abstract: Optimal control of long-term sedation during therapy in the intensive care unit is difficult to achieve in a number of patients when based on commonly used clinical sedation scores alone. We therefore used the median frequency of the EEG power spectrum as a quantitative measure for closed-loop administration of propofol in 21 artificially ventilated patients (nine trauma, 12 non-trauma). The EEG setpoint was correlated with a clinical sedation score and defined such, that mechanical ventilation was tolerated. The sedative therapy was given for 31 +/- 30 h. Non-trauma patients required sedation with an EEG median frequency between 2 and 3 Hz (propofol consumption: 1.4 +/- 0.8 mg kg-1 h-1) and sedation seemed to follow some circadian patterns, whereas trauma patients needed significantly deeper sedation (EEG median frequency: 1-2 Hz; propofol consumption: 2.6 +/- 0.8 mg kg-1 h-1). We conclude that the EEG closed-loop system could safely and reliably administer propofol to maintain a predetermined level of sedation for patients in intensive care unit over a protracted time.
authors.affiliation: Department of Anesthesiology, University of Erlangen Nuremberg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Albrecht
authors.forename: C
authors.initials: C
authors.lastname: Frenkel
authors.forename: H
authors.initials: H
authors.lastname: Ihmsen
authors.forename: J
authors.initials: J
authors.lastname: Schüttler
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D016292:Procedural Sedation; D003422:Critical Care; D004569:Electroencephalography; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000493:pharmacokinetics / Q000627:therapeutic use; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy; D011182:Postoperative Care; D015742:Propofol / Q000493:pharmacokinetics / Q000627:therapeutic use; D012121:Respiration, Artificial
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol