Bispectral Index (BIS) has been used to measure the level of sedation in critically ill patients [].The biggest problems were the artefacts raising from facial muscle or eye movements, and the wide variability of analysed clinical conditions [].BIS-XP is a new available device (Aspect, USA), with one more frontal electrode, that should minimise the movement related artefacts. Study selection and data extraction: Case series, letters, editorials, and clinical studies that evaluated BIS in ICU patients were considered for inclusion. A prospective observation study of medical intensive care patients. Data sources: The bispectral index monitor is connected to a sensor which is placed on the forehead of the patient. 2018 Feb 21;2(2):CD011240. A manual search of abstracts was also performed using the key search terms BIS, sedation, and critical care. During out of office hours and weekends, cEEG monitoring is not always available. The study aimed to investigate the correlation between the BIS index and the prognosis of patients with coma in the ICU. The experts suggest closely monitoring the signs of secondary infection, especially in critically ill patients with COVID-19 who have been admitted to ICU > 48 h (expert opinion). The BIS appeared to correlate better when sedation scores were grouped rather than individual values. Continuing Education Disclosure Statement To assess the effects of BIS monitoring compared with clinical sedation assessment on ICU length of stay (LOS), duration of mechanical ventilation, any cause mortality, risk of ventilator-associated pneumonia (VAP), risk of adverse events (e.g. Epub 2017 Jan 21. Therefore, we have voluntary chosen to investigate BIS monitoring in patients with a Sedation-Agitation Scale score of 1, i.e. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 1 Recommendation. Data synthesis: Nineteen studies comparing the BIS with sedation scales were evaluated, revealing that the BIS trends lower with increasing sedation. Additionally, there was poor correlation between drug dosage and the BIS. Thank you all so much. DAS-Taskforce 2015, Baron R, Binder A, Biniek R, Braune S, Buerkle H, Dall P, Demirakca S, Eckardt R, Eggers V, Eichler I, Fietze I, Freys S, Fründ A, Garten L, Gohrbandt B, Harth I, Hartl W, Heppner HJ, Horter J, Huth R, Janssens U, Jungk C, Kaeuper KM, Kessler P, Kleinschmidt S, Kochanek M, Kumpf M, Meiser A, Mueller A, Orth M, Putensen C, Roth B, Schaefer M, Schaefers R, Schellongowski P, Schindler M, Schmitt R, Scholz J, Schroeder S, Schwarzmann G, Spies C, Stingele R, Tonner P, Trieschmann U, Tryba M, Wappler F, Waydhas C, Weiss B, Weisshaar G. Ger Med Sci. To review and critique evidence for the use of the bispectral index (BIS) in intensive care unit (ICU) patients. This technology is finding its way into the ICU to provide a means of assessing the adequacy of sedation and preventing oversedation of critically ill patients. 2020 Jun;67(6):1696-1706. doi: 10.1109/TBME.2019.2943062. Please enter a term before submitting your search. Cite. The BIS device consists of a transducer that's connected to a monitor on one end and the patient's forehead via an adhesive electrode sensor strip on the other. ECMO. ICU: minimize over/undersedation, potentially lowering costs Kaplan L ,Bailey H. Bispectral Index (BIS) monitoring of ICU patients on continuous infusions of sedatives and paralytics reduces sedative drug utilization. The bispectral index is a statistically based, empirically derived complex parameter. 2018 Sep 14;6:62. doi: 10.1186/s40560-018-0331-7. Implementation of BIS™ technology is often associated with OR clinicians monitoring brain function during sedation. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. BIS™ brain monitoring technology offers a patient-targeted approach for anesthesia management during induction, maintenance, and emergence. Used mainly in paralyzed patients who can’t communicate and hence, can’t use RASS scale. Case series, letters, editorials, and clinical studies that evaluated BIS in ICU patients were considered for inclusion. I have a question. This site needs JavaScript to work properly. This does not replace Train Of Four (TOF) monitoring.  |  we dont use BIS in our ICU but we use neuromonitoring .we use BIS in operation room. DOI: https://doi.org/10.1016/j.chest.2016.08.341. Epub 2019 Sep 23. HHS Interpreting literature on the usefulness of the BIS in the ICU is difficult for reasons that include heterogeneous populations, different methods of collecting BIS data, and use of different versions of BIS software and hardware. doi: 10.1002/14651858.CD011240.pub2. BIS™ consciousness-­monitoring technology is clinically proven to indicate individual patient response to intravenous sedation: Monitor displays real-­time EEG as well as continuous and trend BIS™ index values. To review and critique evidence for the use of the bispectral index (BIS) in intensive care unit (ICU) patients. Clipboard, Search History, and several other advanced features are temporarily unavailable. 2000;4(suppl 1):S110. USE THIS SLIDE FOR BIS A-2000 OR FOR BIS WITH PATIENT MONITORING SYSTEMS OTHER THAN GE OR PHILIPS (Hide the Philips and GE slides) As you can see, the BIS technology is available as a stand-alone monitor or in modular format integrated into leading patient monitoring systems. Previously, BIS™ technology was used in the ICU for a specific purpose ― case-by-case basis during, for example, drug-induced comas. Adaptive Sedation Monitoring From EEG in ICU Patients With Online Learning. The bispectral (BIS) index is a processed electroencephalogram (EEG) parameter with extensive validation and demonstrated clinical utility. Randomized, controlled trials demonstrating improved outcomes with BIS monitoring have not been reported. This system al-lowed for easier, more prompt extubation and a de-creased stay in the ICU. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Proven BIS™ index is easy to read and interpret with recommended ranges. The correlations between serum concentrations and subjective monitoring procedures (RASS and Ramsay Scores) as well as objective monitoring procedures (BIS-monitoring) were investigated in this study. BIS Monitoring in ICU. Shetty RM, Bellini A, Wijayatilake DS, Hamilton MA, Jain R, Karanth S, Namachivayam A. Cochrane Database Syst Rev. •“BIS monitoring is an easy to use adjunct to monitoring sedation in the critically ill patient, that may reduce costs, morbidity, and mortality related to sedation in the ICU” (Ellie Z. Franges, 2009) •“Numerous studies have documented the ability of BIS to reduce intermediate outcomes such as Posted Jun 20, 2015. For those working in Intensive Care Do you ever use BIS Monitoring when you have sedated and ventilated patients, and if so, I would like to know what you think from your experience both with and without Neuromuscular Blocking Agents.  |  Overall, BIS monitoring is an easy-to-use adjunct to monitoring sedation in the critically ill patient that may reduce costs, morbidity, and mortality related to seda-tion in the ICU. A computer search of English-language articles in MEDLINE (1966-July 2005), International Pharmaceutical Abstracts (1971-July 2005), and Scientific Citation Index Expanded (1980-July 2005) was conducted. COVID-19 is an emerging, rapidly evolving situation. However, correlations between BIS and subjective scales were low in most studies (r(2) 0.21-0.93). Objectives: To assess the effects of BIS monitoring compared with clinical sedation assessment on ICU length of stay (LOS), duration of mechanical ventilation, any cause mortality, risk of ventilator-associated pneumonia (VAP), risk of adverse events (e.g. Nurses Nursing. • REFERENCES 1. BIS™ Monitoring Technology Increases Sedation Assessment Capabilities in the ICU. Critical Care Miscellaneous Critical Care, Oxygen Saturation Readouts Generated by the i-STAT Point-of-Care Analyzer Are More Accurate Than Those Generated by the Masimo Radical-7 Pulse Oximeter During Profound Alkalemia, We use cookies to help provide and enhance our service and tailor content and ads. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University.. Both loss of consciousness and awakening from anesthesia are correlated with this scale. We use cookies to help provide and enhance our service and tailor content and ads. We recommend that further studies be conducted to determine the optimal method of obtaining BIS data and evaluate the impact of the BIS on relevant patient outcomes. To monitor a patient, you will need a monitor or a module and a sensor. Nevertheless, one of the potential uses of BIS monitoring in the ICU should be to detect oversedation. What is BIS monitoring in ICU? It is used to monitor the depth of sedation or anesthesia. All patients that are receiving neuromuscular blockade. Bispectral index monitoring gives objective and reliable data where the nurse can base care from, instead of relying mainly from vital signs as well as subjective signs, and thus, pose lesser threats of both undersedation and oversedation.  |  Overall, BIS monitoring is an easy-to-use adjunct to monitoring sedation in the critically ill patient that may reduce costs, morbidity, and mortality related to sedation in the ICU. Identify potential limitations to utilizing BIS monitors for monitoring of sedation in ICU patients on neuromuscular blocking agents. NLM Objective: RESULTS: Average number of patients evaluated was 27. The Bispectral Index (BIS) monitor can be used to assess the hypnotic component of general anesthesia. 27. Sedation will not be discontinued on any patient with neuromuscular blockade based solely on BIS monitor readings. 2015 Nov 12;13:Doc19. By continuing you agree to the Use of Cookies. BIS values increased, indicating that his sedation could be increased without oversedating him. , those who were exposed to a risk of oversedation much more than others. Data synthesis: The BIS represents a method of monitoring that can be an important adjunct to clinical assessment and other monitoring modalities used in the ICU setting. Bispectral index (BIS) monitoring, an objective measure of the patient's response to sedation, has been used in anesthesia for over a decade. Compare the recommendations for the use of BIS monitors between the guidelines for pain/agitation/delirium and neuromuscular blockade. USA.gov. M8002A BIS interface # J16 board for MP30 In the ICU, BIS monitoring has been shown to reduce recall of unpleasant experiences and provide objective sedation assessment during: • Mechanical ventilation • Neuromuscular blockade • Barbiturate coma • Bedside procedures Well managed sedation levels in the ICU can also aid in ventilator weaning. The BIS monitor provides a single dimensionless number, which ranges from 0 (equivalent to EEG silence)to 100 (equivalent to fully awake and alert). doi: 10.3205/000223. Learn more about the costs and benefits in this article. Please enable it to take advantage of the complete set of features! Crit Care. NIH BIS monitoring versus clinical assessment for sedation in mechanically ventilated adults in the intensive care unit and its impact on clinical outcomes and resource utilization. Data Sources: A computer search of English-language articles in MEDLINE (1966–July 2005), International Pharmaceutical Abstracts (1971–July 2005), and Scientific Citation Index Expanded (1980–July 2005) was conducted. BIS manufacturer Aspect Medical Systems says the technology has been used to assess more than five million patients and has been the subject of … Hello. Most studies were done on consecutive ICU admissions. 2017 May;38(5):715-726. doi: 10.1007/s10072-017-2824-x. BIS™ Extend Sensor is made specifically for use in the ICU. Copyright © 2021 Elsevier Inc. except certain content provided by third parties. By continuing you agree to the, https://doi.org/10.1016/j.chest.2016.08.341, Revisiting Bispectral Index Monitors in the Medical ICU: A Review. The two to four sensors on the strip each have numbers that indicate where on the forehead they should be placed for optimal EEG signal analysis. Nineteen studies comparing the BIS with sedation scales were evaluated, revealing that the BIS trends lower with increasing sedation. Bispectral Index (BIS) Monitoring Standard of Practice - ICU. Article BIS monitoring versus clinical assessment for sedation in … St. Joseph Regional Medical Center, Mishawaka, IN, No Product/Research Disclosure Information. Would you like email updates of new search results? BIS monitoring, however, has been shown to be less reliable in anesthetics involving higher-dose opioids and is insensitive to several commonly used anesthetic agents such as ketamine and nitrous oxide. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. REFERENCES eCollection 2018. Indications for Use: 1. Some controlled studies have found that using the BIS reduced the incidence of memory but this was not confirmed in several very large multicenter studies on awareness. Monitoring of sedation depth in intensive care unit by therapeutic drug monitoring? The efficacy of BIS index monitoring is not without controversy. Revision 2015 (DAS-Guideline 2015) - short version. Nies RJ, Müller C, Pfister R, Binder PS, Nosseir N, Nettersheim FS, Kuhr K, Wiesen MHJ, Kochanek M, Michels G. J Intensive Care. BIS monitoring has been used for monitoring anesthesia effects in the operating room for a number of years. Outcomes data are lacking. Azabou E, Fischer C, Guerit JM, Annane D, Mauguiere F, Lofaso F, Sharshar T. Neurol Sci. Earlier emergence with desflurane, compared with sevoflurane and propofol, was also reported when bispectral index (BIS) monitoring was used to titrate the hypnotic agents. The BIS is an electroencephalogram-derived multivariant scale that, when a drug such a propofol is used, correlates with the metabolic rate of glucose. Study selection and data extraction: IEEE Trans Biomed Eng. © 2016 American College of Chest Physicians. To review and critique evidence for the use of the bispectral index (BIS) in intensive care unit (ICU) patients. BIS index is a practical processed EEG parameter that measures the direct effects of sedatives on brain. Using key words “BIS”, “Monitoring”,“ICU” A total 37 English language articles were available on human subjects from 1998 till present. The sensor on forehead sends raw EEG information to the BIS engine. 8 studies met inclusion criteria. A BIS value between 40 and 60 indicates an approp… The aim of this study was to clarify whether or not therapeutic drug monitoring is useful to assess the sedation depth in intensive care patients. Neurophysiological assessment of brain dysfunction in critically ill patients: an update. Purpose: Appropriate treatment of generalized convulsive refractory status epilepticus (RSE) requires general anesthesia in the intensive care unit (ICU) with continuous electroencephalography (cEEG) monitoring. The BIS appeared to correlate better when sedation scores were grouped rather than individual values. A Cochrane review in 2014 found tha… One report used BIS to guide anaesthetic management during necessary dental surgery in persistent vegetative state 67. Simmons LE, Riker RR, PratoBS, FraserGL. Conclusions: It is a weighted sum of electroencephalographic subparameters, including a time domain, frequency domain, and high order spectral subparameters. Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. The 2002 Society of Critical Care Medicine Sedation Guidelines recommendation that more data are needed before the BIS should be used routinely in the ICU remains unchanged. 20th Sep, 2019. A useful application of BIS in ICU is monitoring for seizures that might be subclinical or unrecognised in patients receiving NMB 68. eCollection 2015. Published by Elsevier Inc. All rights reserved. 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