Assessing sedation during intensive care unit mechanical ventilation with the Bispectral Index and the Sedation-Agitation Scale

Simmons, LaVone E.; Riker, Richard R.; Prato, B. Stephen; Fraser, Gilles L.

doi:10.1097/00003246-199908000-00016

Cited by 286 publications

(108 citation statements)

References 28 publications

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“…9 However, it does not appear possible to determine the difference between the actual P aCO 2 and the P aCO 2 apneic threshold (fraction of expired CO 2 -P aCO 2 ) in individual patients receiving mechanical ventilation, without performing individual titration through trial and error.…”

Section: See the Related Editorial On Page 884mentioning

confidence: 99%

Effect of Ventilatory Variability on Occurrence of Central Apneas

et al. 2013

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Section: See the Related Editorial On Page 884mentioning

confidence: 99%

Effect of Ventilatory Variability on Occurrence of Central Apneas

et al. 2013

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“…17 This monitor provides continuous monitoring of the patient's level of sedation, and has been used to titrate sedative medications to patients outside of the operating room as well. 5,18,19 The 100-point BIS scale is less subjective than the physician-reporting scales used in most of the previous studies of PS, and may represent a more reproducible and objective measure of the level of sedation. 20 It is also likely that the BIS score in patients treated with different agents represents the same level of consciousness, allowing for the comparison of given levels of sedation between agents.…”

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confidence: 99%

Bispectral Electroencephalographic Analysis of Patients Undergoing Procedural Sedation in the Emergency Department

Miner

Biros

Heegaard

et al. 2003

Academic Emergency Medicine

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Objective: To determine whether there is a correlation between the level of sedation achieved during procedural sedation (PS) in the emergency department as determined by bispectral electroencephalographic (EEG) analysis (BIS) and the rate of respiratory depression (RD), the patient's perception of pain, recall of the procedure, and satisfaction. Methods: This was a prospective observational study conducted in an urban county hospital of adult patients undergoing PS using propofol, methohexital, etomidate, and the combination of fentanyl and midazolam. Consenting patients were monitored by vital signs, pulse oximetry, nasal-sample end-tidal carbon dioxide (ETCO 2 ), and BIS monitors during PS. Respiratory depression (RD) was defined as an oxygen saturation \90%, a change from baseline ETCO 2 of [10 mm Hg, or an absent ETCO 2 waveform at any time during the procedure. After the procedure, patients were asked to complete three 100-mm visual analog scales (VASs) concerning their perception of pain, recall of the procedure, and satisfaction with the procedure. Patients were divided into four groups based on the lowest BIS score recorded during the procedure, group 1, [85; group 2, 70-85; group 3, 60-69; group 4, \60. Rates of RD and VAS outcomes were compared between groups using chi-square statistics. Results: One hundred eight patients were enrolled in the study. No serious adverse events were noted. RD was seen in three of 14 (21.4%) of the patients in group 1, seven of 34 (20.6%) in group 2, 16 of 26 (61.5%) in group 3, and 18 of 34 (52.9%) in group 4. The rate of RD in patients in group 2 was not significantly different from that in group 1 (p ¼ 0.46). The rate of RD in group 2 was significantly lower than that in groups 3 (p ¼ 0.0003) and 4 (p ¼ 0.006). For the VAS data, when group 1 was compared with the combined groups 2, 3, and 4, it had significantly higher rates of pain (p ¼ 0.003) and recall (p ¼ 0.001), and a dissatisfaction rate (p ¼ 0.085) that approached significance. When groups 2, 3, and 4 were compared with chi-square test, there was not a significant difference in pain (p ¼ 0.151), recall (p ¼ 0.27), or satisfaction (p ¼ 0.25). Conclusions: Patients with a lowest recorded BIS score between 70 and 85 had the same VAS outcomes as more deeply sedated patients and the same rate of RD as less deeply sedated patients. This range of scores represented the optimally sedated patients in this study.

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“…This method employs an electroencephalogram parameters, which was initially developed to assist in the tritration of anesthesia. This assessment provides a scale from 0 to 100, with scores between 90 -100 identifying a wakeful state, 70-80 being unconscious, 60-70 deep level sedation and under 60 being anaesthetised [54], based on an integration of parameters inclusive of EEG, and spectral and bispectral power analysis to determine states of consciousness [55].…”

Section: Objective Sssessment Of Sleep Disturbancementioning

confidence: 99%