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Deep Neuromuscular Blockade Leads to a Larger Intraabdominal Volume During Laparoscopy
Published on: June 25, 2013
Bispectral Index for Titrating Sedation in ARDS Patients During Neuromuscular Blockade
Stephanie Bass1, Mark L Vance2, Anita Reddy2
1Stephanie Bass, Seth R. Bauer, Heather Torbic, and Sarah Welch are intensive care unit clinical pharmacists, Cleveland Clinic, Cleveland, Ohio; Seth Bauer is also the critical care clinical coordinator for the Department of Pharmacy, Cleveland Clinic. Mark L. Vance is a decentralized clinical staff pharmacist at Vidant Medical Center, Greenville, North Carolina. Anita Reddy is a staff physician in the Department of Critical Care Medicine and quality officer for the medical intensive care unit, Cleveland Clinic. Erin Roach is an intensive care unit clinical pharmacist at Atrium Healthcare System, Charlotte, North Carolina. Abhijit Duggal is a staff physician in the Department of Critical Care Medicine, Cleveland Clinic. basss@ccf.org.
Background:
Despite a lack of data from intensive care patients, bispectral index monitors are often used to measure the depth of sedation for critically ill patients with acute respiratory distress syndrome (ARDS) who require continuous neuromuscular blocking agents.
Objective:
To evaluate differences in the effectiveness and safety of monitoring sedation by using bispectral index or traditional methods in patients with ARDS who are receiving continuous neuromuscular blocking agents.
Methods:
This noninterventional, single-center, retrospective cohort study included adult patients with ARDS who are receiving a neuromuscular blocking agent. Daily sedation and analgesia while a neuromuscular blocking agent was being administered were compared between patients with and patients without orders for titration based on bispectral index values. Clinical outcomes also were evaluated.
Results:
Overall, sedation and analgesia did not differ between patients with and patients without titration based on bispectral index. Compared with patients without such titration, patients with bispectral index-based titration experienced more dose adjustments for the sedation agent (median [interquartile range], 7 [4-11] vs 1 [0-5], respectively, P < .001) and the analgesic (1 [0-2] vs 0 [0-1], respectively; P = .003) during the first 24 hours of neuromuscular blockade, but this was not associated with any difference in clinical outcomes.
Conclusions:
Titration based on bispectral index did not result in a significant difference in sedation or analgesia exposure, or clinical outcomes, from that achieved with traditional sedation monitoring in patients with ARDS who were receiving a neuromuscular blocking agent, despite more dose adjustments during the first 24 hours of receiving the neuromuscular blocking agent.
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