Bispectral Index Monitoring in Terminally Ill Patients: A Validation Study

Abstract

This is one of the first validation studies in which BIS monitoring in end-of-life patients is described. BIS monitoring is feasible in unconscious terminally ill patients. However, based on our results, the wide range of BIS values in deeply sedated and comfortable patients seems to hamper its use in daily clinical practice.

Palliative Sedation in Terminal Cancer Patients Admitted to Hospice or Home Care Programs: Does the Setting Matter? Results From a National Multicenter Observational Study

“…Level of consciousness monitoring has seldom been reported before. 25,48 Our data show that it is possible to gradually achieve a desired level of sedation and maintain it until needed to offer symptom control.…”

Population pharmacodynamic modelling of midazolam induced sedation in terminally ill adult patients

“…A continuous measurement using a Bispectral Index Monitor (BIS) has been tested before in terminally ill patients. However, large variability in BIS values for patients with Ramsay scores of 6 were found . Although it may give insight in the onset of sedation, BIS values may be more difficult to use for clinical recommendations.…”

“…This scale consists of six sedation levels: 1, patient is anxious and agitated or restless; 2, patient is cooperative, orientated and tranquil; 3, patient is drowsy or asleep and responds to commands only; 4, patient is asleep and has a brisk response to a light glabellar tap or loud auditory stimulus; 5, patient is asleep and has a sluggish response to a light glabellar tap or loud auditory stimulus; 6, patient is asleep and has no response to a glabellar tap or loud auditory stimulus. The Ramsay sedation score has been used before in a palliative care setting and enables doctors and nursing staff to assess the level of sedation as self‐reporting is usually not possible . The Ramsay score was measured by a trained and experienced nurse, using a standard operating procedure.…”

Breakthrough Medication in Unresponsive Palliative Care Patients: Indications, Practice, and Efficacy

“…Bispectral Index (BIS) monitoring offers some promise, but the application of this technology within the palliative care setting is in its infancy, and more research is required before its contribution to palliative care is clear. 15,19 To complicate matters further, there is lingering uncertainty about what the BIS monitor measures and the significance of the measurements. 18,20,21 Currently, the experience, expertise, and objectivity of the palliative care practitioner determine the accuracy of their assessment and influence decisions concerning intervention.…”