BIS™ Monitoring Technology Increases Sedation Assessment Capabilities in the ICU

Martina Blaho

Implementation of BIS™ technology is often associated with OR clinicians monitoring brain function during sedation. Previously, BIS™ technology was used in the ICU for a specific purpose ― case-by-case basis during, for example, drug-induced comas.

In a typical ICU environment, a 1 to 1 or 1 to 2 ratio of nurse-to-patient has been the common standard. Due to a dramatic influx of patients admitted to the ICUs across the country, clinicians are overwhelmed needing to increase the patient to nursing ratio. This just compounds the strain that’s put on already stressed clinicians.

Clinicians are further supported with the BIS™ system — as an additional sedation-assessment tool in the ICU — through useful implementation in critical care units.¹ Using the BIS™ system as an auxiliary sedation monitor can help mechanically-ventilated patients with improved patient outcomes and a reduction of sedation duration.¹ The use of BIS™ system in the ICU is also associated with decreased lengths of stay and associated costs.¹

Patient benefits associated with BIS™ monitoring technology

Approximately 54 percent of patients are oversedated while just over 15 percent experience under sedation and only 30 percent receive the intended target level of sedation.²This results in a number of lingering side effects among patients.^3,4 Oversedated patients can experience: ^3,4

Nausea
Vomiting
Delayed weaning
Increased length of stay
Pneumonia
Death

Additionally, oversedated patients can experience cognitive impairment and patients 65-years old or older are more susceptible to delirium. Whereas patients that have been under sedated experience side effect such as:^5,6

Extreme anxiety
Post-traumatic stress disorder (PTSD)
Recall or awareness leading to long-term distress

For patients supported by mechanical ventilation or those in a drug-induced coma, the BIS™ system may help clinicians better assess neurological interactions to avoid a daily arousal out of sedation — which may lead to agitation.¹ Determining the appropriate analgesic dose for individual patients varies, but with the BIS™ system the processed EEG data output, and other associated readings allows for improved accuracy.¹

BIS^TM monitoring technology associated with reduced patient stays, costs

Sedated patients are associated with longer dependence on a mechanical ventilator.¹ It’s common to have patients in the current climate be supported for several weeks at a time by a mechanical ventilator. With BIS^TM technology, clinicians may assess the depth of sedation and begin titration, when appropriate, to help wean patients more quickly. Specific patient titration can be more deliberate with BIS™ technology.

While the BIS™ system isn’t intended to monitor sedation levels alone, it’s a tool that helps clinicians understand the patient’s holistic healthcare journey. Whether the patient is transferred from the OR to ICU ensuring appropriate sedation levels are triggered in conjunction with vital sign readings, or the patient has a bedside procedure ― the BIS™ system can help.

Using BIS™ monitoring technology for guided titration has been found to save close to $200 per patient per day.¹

Additionally, BIS™ technology has also been associated with a reduction of sedation costs as well.¹ Clinicians may predict the use of higher levels of propofol, for example. BIS™ technology may indicate otherwise, with EGG data showing that less of the sedative is needed. This may result in faster titration.¹ Adding BIS™ technology to your portfolio of monitoring solutions can lead to improved patient outcomes.

References:
1. Olson DM, Chioffi SM, Macy GE, Meek LG, Cook HA. Potential benefits of bispectral index monitoring in critical care. A case study. Crit Care Nurse. 2003;23(4):45–52.
2. Kaplan L, Bailey H. Bispectral Index (BIS) monitoring of ICU patients on continuous infusions of sedatives and paralytics reduces sedative drug utilization. Crit Care. 2000;4(suppl 1):S110
3. Tobias JD, Grindstaff R. Bispectral index monitoring during the administration of neuromuscular blocking agents in the pediatric intensive care unit patient. J Intensive Care Med. 2005;20(4):233–237.
4. Arbour R. Using bispectral index monitoring to detect potential breakthrough awareness and limit duration of neuromuscular blockade. Am J Crit Care. 2004;13(1):66–73.
5. Wagner BK, Zavotsky KE, Sweeney JB, Palmeri BA, Hammond JS. Patient recall of therapeutic paralysis in a surgical critical care unit. Pharmacotherapy. 1998;18(2):358–363.
6. Bergbom-Engberg I, Haljamäe H. AnchorAssessment of patients’ experience of discomforts during respiratory therapy. Crit Care Med. 1989;17(10):1068–1072.

TOPICS: BIS™ Brain Monitoring, Intensive Care Unit, Sedation Assessment