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