BIS monitoring and sedation titration

[JBMmom]

Hello, our unit recently rolled out BIS monitoring for paralyzed patients. We already use train-of-four for monitoring paralysis. However, the education we were provided on the floor was pretty much how to plug it in and hook it up. We have no parameters on how to use the data for optimizing patient sedation. Do your sedation medications have parameters for titrating to BIS? Do your providers give the sedation orders? Would you titrate up an infusion, or just give a PRN if your BIS numbers go up? I would love any insight so I can bring it back to my unit- our education position isn't filled at this time so there's no one who looked for EBP before this was instituted as a nursing intervention.  In my practice to this point, once we put someone on a paralytic, we don't reduce sedation. We will titrate sedation up if the patient has vent dyssynchrony or hypertension/tachycardia with interventions.  Thank you!

[0.9%NormalSarah, BSN, RN]

Yeah once you paralyze someone the MAR should have parameters to titrate to BIS. You could see about getting a standard order that says basically, “titrate sedative xyz to RASS, if patient is paralyzed titrate to BIS.” Some physicians like neuro surgeons even want them like BIS 20-40, just depends on the reason for paralysis. In respiratory patients, so long as their vitals are stable (not tachy, hypertensive etc) and their BIS doesn’t jump very much suddenly during care, 40-60 is a standard range for them, with good signal quality.