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Bispectral Index Can Reliably Detect Deep Sedation in Mechanically Ventilated Patients: A Prospective Multicenter

Zhu-Heng Wang1, Han Chen, Yan-Lin Yang

  • 1From the *Department of Critical Care Medicine, Beijing Tiantan Hospital, and †Department of Critical Care Medicine, Daxing Teaching Hospital, Capital Medical University, Beijing, China; ‡Surgical Intensive Care Unit, Fujian Provincial Clinical College Hospital, Fujian Medical University, Fuzhou, Fujian, China; §Intensive Care Unit, Beijing Electric Power Hospital, Capital Medical University, Beijing, China; ‖Keenan Research Centre, St Michael's Hospital, Toronto, Canada; and ¶Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.

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|December 28, 2016
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Summary

Deep sedation is common in ventilated patients. Combining baseline and stimulated bispectral index (BIS) monitoring accurately detects deep sedation, improving patient care.

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Area of Science:

  • Critical Care Medicine
  • Neurophysiology
  • Sedation Management

Background:

  • Deep sedation is frequently observed in mechanically ventilated patients, often representing suboptimal care.
  • The bispectral index (BIS), an electroencephalogram-based tool, was investigated for its ability to quantify deep sedation levels.

Purpose of the Study:

  • To evaluate the accuracy of the bispectral index (BIS) in detecting deep sedation in critically ill, mechanically ventilated patients.
  • To determine optimal BIS thresholds for identifying deep sedation using both baseline and stimulated values.

Main Methods:

  • A prospective study enrolled 90 mechanically ventilated patients receiving sedation.
  • Bispectral index (BIS) was monitored for 24 hours and compared with Richmond Agitation Sedation Scale (RASS) assessments every 4 hours.
  • Training and validation sets were used to establish and confirm BIS thresholds for deep sedation (RASS -3 to -5).

Main Results:

  • Although deep sedation was prescribed in only 6.7% of patients, 84.4% experienced at least one episode.
  • Identified BIS thresholds for deep sedation were 50 (baseline) and 80 (stimulated), with areas under the ROC curve of 0.771 and 0.805, respectively.
  • Combined BIS monitoring demonstrated a sensitivity of 85.0% and specificity of 85.9% for detecting deep sedation.

Conclusions:

  • The bispectral index (BIS) shows promise in accurately detecting deep sedation in mechanically ventilated patients.
  • Combining baseline and stimulated BIS measurements enhances the detection of deep sedation, potentially optimizing patient management.