IntroductionICU OverviewBIS Monitor OverviewPatient MonitoringMonitor Setup 
BIS Applications in the ICU

XP Monitor

  • 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:
      • extended time to wake up, weaning, and extubation,
      • increased length of stay,
      • and, potentially unnecessary testing such as CT scans and MRI's.
    • Under-Sedation can result in:
      • 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.
   
  • 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.
   
   
  • 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.
   
   
  • 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:
      • To alleviate anxiety,
      • To allow the patient to tolerate the procedure, and
      • To help identify the risk of awareness.
   
   
  • End-of-Life Care
    • Sedation is a critical component of end-of-life care.
    • The goals of providing sedation are:
      • To alleviate anxiety during the withdrawal of care, and
      • 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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