Critical Care: Miscellaneous Critical Care |

Revisiting Bispectral Index Monitors in the Medical ICU: A Review FREE TO VIEW

Franklin Njoku
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St. Joseph Regional Medical Center, Mishawaka, IN

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):328A. doi:10.1016/j.chest.2016.08.341
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SESSION TITLE: Miscellaneous Critical Care

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: The bispectral index (BIS) monitor is one of the most commonly used objective monitor of sedation depth in ventilated intensive care unit patients on neuromuscular blockade. Available guidelines discourage use as primary monitor in non-paralyzed critically ill patients. This study reviews available literature comparing subjective assessment of sedation versus objective assessment with the BIS monitor, of non-paralyzed mechanically ventilated adult patients.

METHODS: A systematic literature review was conducted to identify studies comparing BIS monitor use in the ICU to standard subjective assessment in non-paralyzed adult patients on mechanical ventilation. A search of Pubmed reference databases was conducted for published relevant studies. Both observational studies and randomized trials were considered. Using key words “BIS”, “Monitoring”,“ICU” A total 37 English language articles were available on human subjects from 1998 till present. 8 studies met inclusion criteria.

RESULTS: Average number of patients evaluated was 27. Most studies were done on consecutive ICU admissions. Study locations were spread out, involving the US, Japan and Europe. Commonest sedative in use was propofol, and the Richmond Agitation Sedation Scale was the most frequently used subjective assessment method. 5 of the 8 studies noted good correlation between the BIS monitor and subjective assessment. 1 study noted better correlation when remifentanil was added to propofol. At deeper levels of sedation, a wide range of BIS value corresponds to highest subjective score. Commonest cited reason for poor correlation was electromyographic interference, and where EMG was used, there was strong correlation between EMG values and BIS.

CONCLUSIONS: In non-paralyzed mechanically ventilated patients, BIS monitoring shows good correlation with well validated sedative assessment scales. However, there is not enough evidence to suggest that BIS can be used alone.

CLINICAL IMPLICATIONS: In situations where subjective assessment is equivocal, bispectral index monitoring may be a useful adjunct to sedation assessment.

DISCLOSURE: The following authors have nothing to disclose: Franklin Njoku

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