Does Bispectral Index Monitoring Belong in the Intensive Care Unit Setting?: A Narrative Review of Evidence

Bispectral Index (BIS) monitoring was introduced in the 1990s to assess the depth of sedation in operating rooms. It is a valuable tool that requires sensor placement on the patient's forehead, setup of the monitor, and subsequent monitoring by a trained health care professional. In recent years, registered nurses have used BIS monitoring in critical care units to assess patient sedation levels. Compared with its use in the operating room, there is limited research on BIS monitoring in critical care settings. More research is needed to validate the safety and effectiveness of BIS monitoring in critical care units.

Using a narrative review research design, the authors analyzed the current literature investigating the application of BIS monitoring by registered nurses in critical care settings. The study aimed to provide an overview of the current state of knowledge on the application of BIS monitoring in critical care units and identify gaps in the current literature.

A narrative review research design was used, yielding 244 articles following the initial keyword search. Two reviewers independently reviewed the relevant titles and abstracts to determine which articles met the inclusion and exclusion criteria. Further analysis yielded 10 articles for further review.

An evidence table was organized, including 10 articles. The source details, findings, and evidence ranking using the Oxford Level of Evidence Scale were described for each article. The evidence synthesis of published research studies revealed 3 themes. First, when used as an adjunct to Richmond Agitation-Sedation Scale, BIS can reliably identify deep sedation in intubated, sedated, and critically ill patients. Second, current research suggests that the integration of BIS monitoring in critical care settings is associated with decreased medication use and lower costs. Third, BIS monitoring use is linked to a reduction in medical complications such as respiratory depression, aspiration, delirium, and prolonged critical care stays arising from oversedation.

The current literature supports the incorporation of BIS monitoring into the sedation monitoring and assessments of adult critical care patients. Registered nurses can competently use BIS monitoring in the intensive care unit with proper training and education. Key advantages of BIS monitoring include the accurate measurement of patient sedation, reduced sedation medication use, lower health care costs, and a decrease in patient complications related to oversedation. Future studies using experimental designs and systematic reviews are recommended to measure the benefits of BIS monitoring and assess the impact of its use, thereby further supporting its application in critical care units.

The findings suggest that integrating BIS monitoring in critical care units may benefit patient outcomes by improving reliable sedation assessments. Future research using experimental designs is needed to enhance the generalizability of the findings.