| Objective:To study the correlation between spectral entropy and Ramsay score in the evaluation of sedation depth of mechanically ventilated children,to evaluate whether spectral entropy can be used as a quantitative index of sedation depth of mechanically ventilated children,and to study the ability of spectral entropy to predict the prognosis of mechanically ventilated children with early sedation.Methods:31 children with mechanical ventilation admitted to PICU from December2021 to December 2022 were divided into deep sedation group(Ramsay score≥5)and shallow sedation group(Ramsay score≤4)according to the Ramsay score.Within 24hours and 48 hours after the start of mechanical ventilation,respectively,after the initial reading(baseline).The spectral entropy,Ramsay value and the Critical Care Pain Observation Tool(CPOT)were recorded in 5min,15min,30min,45min,60min,75min,90min,105min and 120min,respectively,and the sedation and analgesia dose was adjusted to maintain a certain sedation and analgesia depth.Spearman’s rank correlation analysis was used to analyze the correlation between spectral entropy and Ramsay score.The prognosis of mechanically ventilated children with pneumonia was evaluated by modified PIRO score(Predisposition,Infection,Response and Organ Failure Scale,PIRO).According to the modified PIRO score,the children were divided into two groups:the good prognosis group and the poor prognosis group.Spearman’s rank correlation analysis was used to analyze the correlation between modified PIRO and spectral entropy and the correlation between modified PIRO and Ramsay score.Age,sex,BMI,Ramsay score,spectral entropy,modified PIRO score,hospital stay,mechanical ventilation time and P/F value were compared between groups.The clinical characteristics,clinical end point and prognosis of children with different sedation depth were compared between the two groups.Independent sample t-test was used to compare the measurement data of normal distribution between the two groups.Mann-Whitney U test was used to compare the measurement data of non-normal distribution between the two groups.The Fisher exact probability method was used to compare the counting data between the two groups,and the spectral entropy and Ramsay score were analyzed by ROC curve to evaluate the ability to predict the prognosis.Results:There was no significant difference in age,sex and BMI between the two groups(P>0.05).There was no significant difference between the two groups in intensive care pain observation tool(CPOT)(P>0.05).With the deepening of sedation depth,the monitoring value of spectral entropy gradually decreased,and there was a negative correlation between spectral entropy and Ramsay[(r~2=-0.787,P<0.001)].The spectral entropy of deep sedation group(34.0±1.0)was significantly lower than that of shallow sedation group(52.7±6.3)(P<0.001).According to the modified PIRO score,the children with pneumonia were divided into two groups:good prognosis group(modified PIRO score was 0-2)and poor prognosis group(modified PIRO score≥3).The spectral entropy in the good prognosis group(49.5±8.0)was significantly higher than that in the poor prognosis group(42.1±10.4)(P=0.047).And the hospitalization time of the group with poor prognosis[20.5(27.0)]was higher than that of the group with good prognosis[14.0(6.0)],the difference was not statistically significant(P=0.191).The duration of mechanical ventilation in the good prognosis group(151.7±41.2)was significantly lower than that in the poor prognosis group(414.9±264.1)(P=0.012).With the deepening of sedation depth,the hospitalization time of deep sedation group[15.0(20.0)]was shorter than that of shallow sedation group[13.5(6.0)],the mechanical ventilation time of deep sedation group[237.0(485.0)]was lower than that of shallow sedation group[165.0(87.0)],the incidence of nosocomial infection in deep sedation group[4 cases(44.4%)]was higher than that in shallow sedation group[4 cases(18.2%)]and the incidence of ventilator-associated pneumonia in deep sedation group[2 cases(22.2%)]was higher than that in shallow sedation group[2 cases(9.1%)],but the difference was not statistically significant(P>0.05).With the deepening of sedation,there was no significant increase or decrease in hospital mortality and 28-day mortality,and the difference was not statistically significant(P>0.05).Ramsay score had statistical significance in evaluating the prognosis of children who were in mechanical ventilation with pneumonia(P<0.05).The AUC was 0.329,the sensitivity and specificity were 50%and 84.2%respectively,and the cut-off value of good prognosis was 4.5.The spectral entropy had statistical significance in evaluating the prognosis of children who were in mechanical ventilation with pneumonia(P<0.05).The AUC was 0.715,the sensitivity and specificity were 100%and 50%respectively,and the cut-off value of good prognosis was 34.6.Conclusions:There is a good correlation between spectral entropy and Ramsay.Spectral entropy can better monitor the sedation depth of children and can be used as an objective quantitative index for sedation evaluation.It has a certain role in evaluating the prognosis of mechanically ventilated children with pneumonia.It is a direct,objective and quantitative electrophysiological index that can be used to evaluate the prognosis of early sedated and mechanically ventilated children with pneumonia.With the deepening of sedation,the length of stay,the time of mechanical ventilation,the incidence of nosocomial infection and the incidence of ventilator-associated pneumonia increased. |
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