Awareness and bispectral index (BIS) monitoring in mechanically ventilated patients in the emergency department and intensive care unit: a systematic review protocol

Abstract

IntroductionAccidental awareness with recall is one of the most feared complications for patients undergoing general anaesthesia and can lead to post-traumatic stress disorder in up to 70% of patients experiencing it. To reduce the incidence of awareness with recall, the bispectral index monitor is recommended for patients receiving total intravenous anaesthetics, especially those receiving neuromuscular blockers. While extensive investigation into awareness and bispectral index monitoring has occurred for operating room patients, this has not extended to other clinical arenas where sedated and mechanically ventilated patients are cared for, namely the intensive care unit and emergency department. The purpose of this systematic review is to assess the world’s literature to determine the incidence of awareness with paralysis in mechanically ventilated patients and the impact of bispectral index monitoring for reducing this complication.Methods and analysisRandomised trials and non-randomised studies are eligible for inclusion. With aid from a medical librarian, an electronic search will include Ovid Medline, Embase.com, Scopus, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. To find data published in abstract form, literature from professional society conferences (2010–2019) will be manually searched. Two authors will independently review search results and consensus will be reached with assistance from a third author, as needed. Heterogeneity and publication bias will be assessed and reported. If possible and appropriate, a meta-analysis of the data will be conducted for quantitative data analysis.Ethics and disseminationThe proposed systematic review does not require ethical approval, as it is conducted at the study level and does not involve individual patient-level data. Results will be disseminated by data sharing via academically established means, presentation at local and national scientific meetings and publication as a peer-reviewed manuscript.PROSPERO registration numberThe protocol has been submitted to International Prospective Register of Systematic Reviews and is awaiting registration.

Myorelaxants in ARDS patients

“…Neither the ARDS et Curarisation Systematique (ACURASYS) study nor the Reevaluation of Systemic Early Neuromuscular Blockade (ROSE) study used sedation surveillance monitors in the NMBA arms; all the patients received deep sedation, and neither trial allowed decreasing the sedation after the initiation of NMBAs [ 37 , 54 ]. Bispectral index (BIS) monitor is a noninvasive processed electroencephalogram that can identify accidental awareness with recall (AWR) in patients undergoing general anaesthesia [ 66 ]. BIS values of 40–60 minimize the risk of AWR in operating rooms [ 66 ].…”

“…Bispectral index (BIS) monitor is a noninvasive processed electroencephalogram that can identify accidental awareness with recall (AWR) in patients undergoing general anaesthesia [ 66 ]. BIS values of 40–60 minimize the risk of AWR in operating rooms [ 66 ]. Despite minimal data to corroborate its use in the ICU [ 67 ], BIS monitoring is becoming more common in mechanically ventilated patients undergoing paralysis [ 68 ].…”

“…Electromagnetic fields from other devices and instruments in the ICU environment might also affect BIS readings [ 67 , 69 ]. The use of BIS monitors in clinical practice has been associated with increased rates of the down titration of sedatives, and the risk of under-sedating these patients needs to be always evaluated when using any monitoring devices to prevent long-term neuro-cognitive disorders, such as anxiety or post-traumatic stress disorder [ 66 , 70 ]. BIS values should, moreover, be interpreted with caution as they have been shown to decline in fully awake volunteers under neuromuscular block [ 71 , 72 ].…”

Comparison of Quantium Consciousness Index and Richmond Agitation Sedation Scale in Mechanically Ventilated Critically Ill Patients: An Observational Study

“…In such circumstances, the practitioner needs to rely on other parameters to assess the sedation depth. 7 The unreliability of commonly used sedation scales in conditions where the patient is nonresponsive due to muscle relaxation leads to various objective methods of assessment. The objective methods of assessing sedation in mechanically ventilated patients are Bispectral Index (BIS), 8 Entropy, 9 Narcotrend, 10 and others.…”

Polyspikes and Rhythmic Polyspikes During Volatile Induction of General Anesthesia With Sevoflurane Result in Bispectral Index Variations

“…6,7 Utility of depth of anesthesia monitors (DOA) imposes an extra the cost so it must be balanced with potential advantages for anesthesiologists, 8-11 which depend on numerous factors, like probability of awareness. 1,12,13 For example, although the incidences of BIS >60 are very common in obese patients, true awareness during anesthesia is infrequent in this group of patients whether anesthesia was intravenous or through inhalation. 14…”