Does Anyone Use The Bispectral Index (BIS) Routinely To Assess Sedation?

[steve0123]

I was just flicking through some journals a while ago (as one does) and a little piece on the BIS caught my fancy...

I looked into it a bit more, and there seemed to be a push recently for ICU nurses to routinely use the bispectral index (a type of EEG reading) to assess the efficacy of sedation. The only thing is, I've never seen them in use anywhere outside of theatre (now that may be due to a lack of experience or just from working in a smaller hospital)... Was just wondering if anyone works anywhere that uses EEG technology in ICU continuously for this purpose, and what your thoughts on it are (ie: does it improve your nursing care, or is it just another machine to contend with)?

The idea is that risk for delirium and other complications to do with over/under sedation should be reduced by allowing closer monitoring.

[heartICU]

My hospital uses it somewhat frequently, but typically in my unit we use it only for patients that are receiving paralytics. Since you can't assess sedation level while patients are paralyzed, we use the BIS to guide our sedative dosages. Typically we will sedate with fentanyl and propofol continuously as vitals permit, then give intermittent ativan doses to keep the BIS below X (whatever the MD orders...usually 50-60).

I have heard that it's accuracy is rather controversial...(i.e. the studies that report its success were apparently funded by the company that made the device), so I am not sure how accurate it is. We have one in all of our ORs and two in our ICU. (I work in a CTICU). I am not sure if other units use it...we have a MICU, CICU, SICU, NICU, and Heart Failure ICU in addition to five CTICUs...in an average week, we probably use the BIS on three or four different patients.

[AmiK25]

We also use the BIS on all patients receiving paralytics. We can also use the BIS monitor anytime we feel it is necessary to assess sedation. I think our Neuro ICU also uses them for patients in a pentobarb coma.

[steve0123]

Oh OK - I forgot to mention in the post that the push was to use the BIS to monitor sedation in all patients on NMBA's. I take it from the less than overwhelming response that the use of EEG technology for this purpose isn't too wide spread yet. Personally, I think it's a great idea (yes yes I know... **another** machine to contend with...), but then again I haven't ever used one. Interesting to read about the questionable accuracy though...

[RNforLongTime]

We trialed the BIS monitor in my unit last summer. I loved it. Unfortunately the powers that be decided that it was too expensive. I guess each electrode that attaches to the pt's forehead costs like $17 each.

[steve0123]

Isn't that lousy! I understand that healthcare resources are finite and bla bla bla, and that we have to use equipment/treatments/etc judiciously, but when you think about how much extra money it costs to look after a patient with ICU psychosis, or to pay out in a lawsuit as damages for the "trauma" of being undersedated, etc, $17 per electrode looks like a much more rational solution. Maybe its just another example of asking nurses to do more with less (after all, if an anaesthetist wanted a new BIS monitor, I'm sure it would be in the post by 5pm... ). Dammit! I want a BIS machine!!! And I won't stop until I get one :chuckle