Pitfalls of Monitoring Sedation in the Icu With the Bispectral Index

O’Connor, Mark; Kress, John P.; Pohlman, Anne S.; Tung, A; Hall, Jean A.

doi:10.1097/00000542-199809080-00085

Cited by 17 publications

(14 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In another study, the same group reported asymmetric BIS scores in patients with abnormal brain computed tomographic scans (28). O'Connor and coworkers (29) reported large variances in BIS scores in their study of 29 patients with neurologic diseases. Fabregas and colleagues (30) reported BIS monitoring to be an outcome predictor in severely brain damaged unconscious patients.…”

Section: Discussionmentioning

confidence: 96%

Bispectral Index monitoring correlates with sedation scales in brain-injured patients*

Deogaonkar

Gupta

DeGeorgia

et al. 2004

Critical Care Medicine

138

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 96%

Bispectral Index monitoring correlates with sedation scales in brain-injured patients*

Deogaonkar

Gupta

DeGeorgia

et al. 2004

Critical Care Medicine

138

View full text Add to dashboard Cite

show abstract

“…BIS is useful in the ICU for monitoring sedation (and preventing over-sedation) and for shortening the duration of ICU stay, and a consequent decrease in hospital costs associated with its use may be anticipated [15]. However, several questions have been raised regarding the use of BIS in the ICU concerning the widespread use of opioids (which reduces the validity of BIS) [15,16], interpretation difficulties in neurological diseases [17] and controversial studies that demonstrated decreased correlation between clinical sedation scores and BIS [17-19]. For example, a study conducted in a paediatric ICU [20] demonstrated that opioids do provide some degree of sedation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of sufentanil with sufentanil plus magnesium sulphate for sedation in the intensive care unit using bispectral index

et al. 2003

View full text Add to dashboard Cite

Correspondence: Dilek Memis ², dilmemis@mynet.com R123 APACHE = Acute Physiology and Chronic Health Evaluation; BIS = bispectral index; ICU = intensive care unit. AbstractIntroduction In intensive care unit patients we assessed, using bispectral index (BIS) monitoring, whether the addition of magnesium sulphate infusion could decrease the sufentanil infusion required to maintain sedation. Patients and methods A total of 30 adult patients who were expected to require machanical ventilation for 6 hours in the intensive care unit were randomly assigned to receive either sufentanil infusion or sufentanil plus magnesium infusion. We monitored BIS levels continously. BIS levels in the range 61-88 are required to maintain a state of sedation, and in both groups BIS levels were kept within this range by increasing or decreasing the sufentanil infusion. Hourly consumption of sufentanil was monitored. Cardiovascular, respiratory and biochemical data were recorded. Results There was no significant difference between the groups with respect to cardiovascular, respiratory and biochemical parameters. Magnesium infusion, when added to sufentanil infusion, decreased the consumption of sufentanil at all times accept during the first hour (P < 0.001). There was no significant difference in BIS values between the groups (P > 0.05). Conclusion This is the first clinical study to demonstrate that magnesium sulphate infusion decreases sufentanil requirements. Because of the limited number of patients included and the short period of observation, our findings must be confirmed by larger clinical trials of magnesium infusion titrated to achieve prespecified levels of sedation. Furthermore, randomized clinical studies are needed to determine the effects of magnesium infusion on opioids.

show abstract

“…Encephalopathy is associated with EEG slowing, similar to that seen with sedation; this can result in lower BIS values than expected in a small proportion of patients. 16,24 One study found a correlation between abnormal neurologic score and BIS in a convenience sample of patients who had not received a sedative drug in the preceding 24 hours. 25 In another study, BIS values were significantly lower in outpatients with dementia than in an age-matched control group of postsurgical patients (89 vs 95, p=0.002).…”

Section: Abnormal Brain Activitymentioning

confidence: 99%

“…The EEG (and thus the BIS) can be affected by natural sleep, neurologic disease, encephalopathy, cerebral ischemia, hypothermia, genetically determined low-voltage patterns, EMG, and even the choice of sedation (ketamine-based approaches may activate the EEG and keep the BIS high). [15][16][17][18][19][20]…”

mentioning

confidence: 99%

Bispectral Index Monitoring in the Intensive Care Unit Provides More Signal Than Noise

Fraser

Riker

2005

Pharmacotherapy

View full text Add to dashboard Cite

The bispectral index (BIS) is processed electroencephalographic technology used in concert with clinical evaluations to objectively evaluate a patient's level of consciousness and probability of recall. Although the BIS has been extensively studied in the operating room setting, differences in patient populations, goals of treatment, and the environments themselves necessitate the development of BIS data specific to the intensive care unit. Data have evolved over the last several years, but for many reasons, the results and conclusions have varied. Yet within the data are important consistencies that help define the usefulness of BIS in patients who cannot be evaluated with subjective assessment tools such as the Sedation-Agitation Scale or the Richmond Agitation-Sedation Scale. Some of these patients cannot be evaluated with such tools because they lack motor responsiveness due to therapeutic paralysis or because they are receiving deep sedation. Bispectral index scores that are higher than expected in clinically sedated patients can often be traced to electromyographic activity or to the possibility of inadequate sedation and analgesia. The BIS must not be regarded as the sole indicator of level of consciousness, but should be used as part of an integrated approach to the evaluation of carefully selected patients with critical illness.

show abstract

Pitfalls of Monitoring Sedation in the Icu With the Bispectral Index

Cited by 17 publications

References 0 publications

Bispectral Index monitoring correlates with sedation scales in brain-injured patients*

Bispectral Index monitoring correlates with sedation scales in brain-injured patients*

Comparison of sufentanil with sufentanil plus magnesium sulphate for sedation in the intensive care unit using bispectral index

Bispectral Index Monitoring in the Intensive Care Unit Provides More Signal Than Noise

Contact Info

Product

Resources

About