Utility of bispectral index in the management of multiple trauma patients

Abstract

Background:Bispectral index (BIS) monitoring in multiple trauma patients has become a common practice in monitoring the sedation levels. We aimed to assess the utility of BIS in the trauma intensive care unit (ICU).Methods:A prospective observational study was conducted in the trauma ICU at Hamad General Hospital in Qatar between 2011 and 2012. Patients were divided in two groups: Group I (without BIS monitoring) and Group II (with BIS monitoring). The depth of sedation was clinically evaluated with Ramsey Sedation Scale, changes in vital signs and Glasgow Coma Scale (GCS) level. Use of sedatives, analgesics, and muscle relaxants were also recorded. Data were compared using Chi-square and Student t-tests.Results:A total of 110 mechanically ventilated trauma patients were enrolled with a mean age of 36 ± 14 years. The rate of head injury was greater in Group I when compared with Group II (94% vs. 81%, P = 0.04). In comparison to Group I, patients in Group II had lower GCS and higher mean Injury Severity Score (ISS) (6.3 ± 2.5 vs. 7.4 ± 2.7 and 25.5 ± 8.5 vs. 21.2 ± 4.7, respectively, P = 0.03). The used midazolam dose was less in Group II in comparison to Group I (5.2 ± 2.3 vs. 6.1 ± 2.1, P = 0.03). Also, fentanyl dose was less in Group II (152 ± 58 vs. 187 ± 59, P = 0.004). The rate of agitation, failure of extubation and tracheostomy in Group II were lower than those in Group I, P = 0.001. The length of stay for patients Group I was longer (14.6 ± 7.1 vs. 10.2 ± 5.9 days) in comparison to group II, P = 0.001.Conclusion:Management of multiple trauma patients in the trauma ICU with BIS monitoring was found to be associated with better outcomes. BIS monitoring is a guide for adjusting the dosage of sedative agents. It can also minimize agitation, failure of extubation, and length of stay in ICU.

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

“…Rationale: The literature for ICU-based studies of objective monitoring tools for sedation consists primarily of reports for electroencephalogram-based tools (particularly the BIS). Few ICU-based studies evaluated outcome benefits (208)(209)(210) (161,.…”

“…Three studies evaluated the effect of using the BIS to assess sedation compared with using a subjective tool (209)(210)(211). These showed reductions in total sedative use and faster wakening times despite similar clinical sedation (Ramsay 4) (208), a reduction in procedure-related adverse events (Ramsey 2-3) (209), and reduced midazolam and fentanyl doses, less agitation, less need for tracheostomy, and shorter ICU LOS (210).…”

Essential Noninvasive Multimodality Neuromonitoring for the Critically Ill Patient

“…No difference was found in the total amount of administered sedative drugs, length of mechanical ventilation, or ICU length of stay. In a recent study on 110 trauma patients, use of BIS resulted in a decrease in sedation and analgesia use, decrease in agitation, less failure to extubate, and fewer tracheostomies, with an approximate 4-day decreased length of stay [46].…”

Important Issues in Coma and Neuromonitoring

“…BIS components are beta ratio and SyncFastSlow. Beta ratio is the logarithm of the ratio of two frequency components of the spectral power (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47) Hz and 11-20 Hz), while SyncFastSlow is the logarithm of the bispectral ratio of 0.5-47 Hz and 40-47 Hz [36].…”

“…BIS monitoring can be used in the intensive care wards as well, to monitor patient sedation [38]: in traumatic brain injury, a value under 60 correlates with a negative prognosis [39]. BIS monitoring may also be used to detect cerebral vasospasm in critical patients [40]; it has been proven that it correlates well with the consciousness level of the ICU patients, it aids in adjusting sedative dosage, it has a prognostic value and it is useful in monitoring induced coma for a status epilepticus [41][42][43][44].…”