A comparison of SNAP II© and bispectral index monitoring in patients undergoing sedation

Springman, Scott R.; Andrei, Adin Cristian; Willmann, Karl; Rusy, Deborah A.; Warren, Miranda; Han, S.; Lee, M.

doi:10.1111/j.1365-2044.2010.06408.x

Cited by 7 publications

(6 citation statements)

References 28 publications

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“…[112] This finding was also reported by a 2006 overview of 19 studies comparing the BIS ª with other sedation scales, which identified poor correlation between sedative drug doses and BIS ª scores, and recommended that ''further studies be conducted to determine the optimal method of obtaining BIS data and to evaluate the impact of BIS on relevant patient outcomes.'' [120] Thus, although there have been improvements, based on our review of a representative sampling of the more recent literature, [97,99,100,[102][103][104][105][106][107][108][109][110][111][112][115][116][117]119,[121][122] the reported concerns regarding BIS ª still remain valid. We suggest that further appropriately designed studies be conducted before BIS ª monitoring be routinely adopted in the ICU.…”

Section: Tools For Monitoring and Assessing The Adequacy Of Sedationmentioning

confidence: 99%

Sedation for Critically Ill or Injured Adults in the Intensive Care Unit

Roberts

Haroon

Hall

2012

Drugs

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As most critically ill or injured patients will require some degree of sedation, the goal of this paper was to comprehensively review the literature associated with use of sedative agents in the intensive care unit (ICU). The first and selected latter portions of this article present a narrative overview of the shifting paradigm in ICU sedation practices, indications for uninterrupted or prolonged ICU sedation, and the pharmacology of sedative agents. In the second portion, we conducted a structured, although not entirely systematic, review of the available evidence associated with use of alternative sedative agents in critically ill or injured adults. Data sources for this review were derived by searching OVID MEDLINE and PubMed from their first available date until May 2012 for relevant randomized controlled trials (RCTs), systematic reviews and/or meta-analyses and economic evaluations. Advances in the technology of mechanical ventilation have permitted clinicians to limit the use of sedation among the critically ill through daily sedative interruptions or other means. These practices have been reported to result in improved mortality, a decreased length of ICU and hospital stay and a lower risk of drug-associated delirium. However, in some cases, prolonged or uninterrupted sedation may still be indicated, such as when patients develop intracranial hypertension following traumatic brain injury. The pharmacokinetics of sedative agents have clinical importance and may be altered by critical illness or injury, co-morbid conditions and/or drug-drug interactions. Although use of validated sedation scales to monitor depth of sedation is likely to reduce adverse events, they have no utility for patients receiving neuromuscular receptor blocking agents. Depth of sedation monitoring devices such as the Bispectral Index (BIS©) also have limitations. Among existing RCTs, no sedative agent has been reported to improve the risk of mortality among the critically ill or injured. Moreover, although propofol may be associated with a shorter time to tracheal extubation and recovery from sedation than midazolam, the risk of hypertriglyceridaemia and hypotension is higher with propofol. Despite dexmedetomidine being linked with a lower risk of drug-associated delirium than alternative sedative agents, this drug increases risk of bradycardia and hypotension. Among adults with severe traumatic brain injury, there are insufficient data to suggest that any single sedative agent decreases the risk of subsequent poor neurological outcomes or mortality. The lack of examination of confounders, including the type of healthcare system in which the investigation was conducted, is a major limitation of existing pharmacoeconomic analyses, which likely limits generalizability of their results.

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Section: Tools For Monitoring and Assessing The Adequacy Of Sedationmentioning

confidence: 99%

Sedation for Critically Ill or Injured Adults in the Intensive Care Unit

Roberts

Haroon

Hall

2012

Drugs

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“…As the range of BIS values for a given sedation scale value is large, documenting the trend changes in BIS values should be a more acceptable marker of level of consciousness than absolute BIS scores. In our opinion, its current value and perhaps that of other brain function monitors, including the Narcotrend©, [52] Patient State Index, [37] Entropy© Module [36] and SNAP II© [53]) may lie in the ability to provide more information of the degree of sedation among patients receiving neuromuscular receptor blocking agents. Despite the effectiveness of these methods at the current state, we need more evidence in this field to confirm the existing data in the literature.…”

Section: Resultsmentioning

confidence: 99%

Evaluation of Sedation for the Unconscious Patient: Are We Still Far Away?

Laurenza¹

2014

JACCOA

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“…No pediatric data exist comparing the BIS with the SNAP II. Data from adult studies have found that the two indices are not interchangeable but that both devices can reliably monitor the level of sedation in adult patients undergoing general anesthesia . In fact, because the SNAP II assesses both high and low‐frequency EEG compared with the BIS which only assess low‐frequency EEG, the SNAP index has been suggested to be a better predictor of impending wakefulness .…”

Section: Discussionmentioning

confidence: 99%

The SNAP index does not correlate with the State Behavioral Scale in intubated and sedated children

Thompson

Shabanova

Giuliano

2013

Pediatric Anesthesia

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Background Ensuring appropriate levels of sedation for critically ill children is integral to pediatric critical care. Traditionally, clinicians have used subjective scoring tools to assess sedation levels. The SNAP II uses dual frequency processed electroencephalography to evaluate brain activity and may provide an objective assessment of sedation levels. Objective This study attempts to find an objective method to monitor sedation in critically ill pediatric patients. We compared the SNAP II, a processed electroencephalography device, with the State Behavioral Scale (SBS), a subjective sedation scoring tool. We hypothesize that the SNAP II correlates with the SBS and has less observer bias. Methods This was an IRB approved prospective, observational study. Patients receiving intravenous sedation while being mechanically ventilated were enrolled after informed consent. After the SNAP II monitoring electrodes were attached, blinded bedside nurses assessed sedation levels using the SBS. SNAP indices were collected and compared with SBS scores to determine correlation. Results We compared 417 paired data points from 15 patients using Pearson's correlation and Least Squares Means to determine correlation between the SBS and SNAP indices. No correlation was observed. Using covariance model patterning for repeated measures to adjust for covariates again showed no correlation. Conclusion The SNAP index does not correlate with SBS scores in our PICU. Its use cannot be recommended to measure levels of sedation in our population. Future research should continue to explore objective ways of measuring sedation in critically ill children.

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A comparison of SNAP II© and bispectral index monitoring in patients undergoing sedation

Cited by 7 publications

References 28 publications

Sedation for Critically Ill or Injured Adults in the Intensive Care Unit

Sedation for Critically Ill or Injured Adults in the Intensive Care Unit

Evaluation of Sedation for the Unconscious Patient: Are We Still Far Away?

The SNAP index does not correlate with the State Behavioral Scale in intubated and sedated children

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