BISPECTRALINDEXMONITOTING.pptVIP

ICU SKILLS UPDATE February/March 2007 By Dianne Brown ICU Skills Update Theory and Hands On Practice Bispectral Index Monitoring BISPECTRAL INDEX MONITOTING BISPECTRAL INDEX MONITORING The bispectral index (BIS) is a fairly recent technology used to measure the effects of anesthetics and sedatives on the brain and consciousness Uses a complex mathematical algorithm based upon descriptive EEG parameters from the frontal cortex to suggest various levels of sedation BISPECTRAL INDEX MONITORING A sensor, placed on the patient’s forehead, sends raw EEG waveforms to the monitor, where they are analyzed and a BIS index is calculated This value ranges from 100 (completely awake) to 0 (isoelectric EEG) BISPECTRAL INDEX MONITORING BISPECTRAL INDEX MONITORING Understanding the relationship between BIS and EEG When BIS monitoring is initiated, a sensor is placed across the patient’s forehead per manufacturer’s recommendations to detect one channel of EEG activity The EEG signal is filtered and digitalized The EEG state (frequency/amplitude) is calculated and associated with the level of sedation, arousal or anesthesia Understanding the relationship between BIS and EEG The BIS value is a single number based on the previous 15 seconds of EEG data and is updated frequently The BIS monitor provides a single channel of an EEG tracing from the right or left frontal-temporal montage electrode placement ICU Sedation: A Bipolar Challenge Over-sedation Patient unable to participate in care Delayed weaning ↑Ventilator-associated pneumonia ↑Unnecessary testing ↑ICU and hospital length of stay ↑Costs Under-sedation Anxiety, agitation ↑Cost, nursing time ↑Use of neuromuscular blocking agents ↑Risk of recall/awareness of unpleasant events ↑Unintended medical device removal Potential Indications for BIS Monitoring Use with neuromuscular blockade: BIS monitoring may help to identify patients at risk of awareness, recall and pain when paralyzed Use of BIS values to guide sedation an