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BIS
Applications in the ICU
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- BIS may
be used to monitor a patient’s sedation level for a variety
of ICU applications including:
- Mechanical
Ventilation
- Over-sedation
may occur with both short term and long term sedation. Complications
include:
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extended time to wake up, weaning, and extubation,
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increased length of stay,
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and, potentially unnecessary testing such as CT scans
and MRI's.
- Under-Sedation
can result in:
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anxiety,
- agitation,
- awareness,
- recall
of unpleasant experiences,
- and
increased adverse events such as deliberate medical device
removal or patient or staff injury.
- Patients
who are receiving moderate to deep sedation for mechanical
ventilation are excellent candidates for BIS monitoring. These
patients may not be responsive to light forms of stimulation,
which often makes it difficult to determine exactly how deeply
sedated they are. The adequacy of sedation for mechanical
ventilation is also often critical to effectively manage the
ventilation requirements of patients, particularly those on
non-physiologic ventilatory modes. The use of BIS monitoring
may help to avoid the use of neuromuscular blocking agents
with better-controlled sedation.
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- Neuromuscular
Blockade
- Neuromuscular
blockade blunts the clinical signs of sedative depth. BIS
monitoring can help to avoid inappropriate sedation levels
by providing objective information where sedation assessment
scales cannot be used.
- Objective
sedation assessment for paralyzed patients is important to
reduce the risk of
- Awareness
during paralysis
- Recall
of unpleasant experiences,
- The
consequences of Over sedation, and
- To
provide reassurance to staff and family.
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- Drug-Induced
Coma.
- BIS
monitoring provides a simplified, bedside interpretation of
patient response to treatment allowing the sedative infusion
to be easily and individually titrated to achieve burst suppression.
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- Bedside Procedures.
- Patients
undergoing bedside procedures have the same needs as patients
in the operating room, and BIS monitoring can be helpful in
both environments:
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To alleviate anxiety,
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To allow the patient to tolerate the procedure, and
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To help identify the risk of awareness.
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- End-of-Life
Care
- Sedation
is a critical component of end-of-life care.
- The
goals of providing sedation are:
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To alleviate anxiety during the withdrawal of care, and
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To assure the family and staff that the patient is in
a state of unconsciousness.
- BIS
can help to assure that patients aren’t aware and experiencing
anxiety during withdrawal of care.
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