South West Anaesthesia Research Matrix

  SWARM

The Use of Bispectral Index (BIS) to Guide Sedation Practice In the ICU

 
In January 2015, SWARM was involved in collecting data for a collaborative project initiated by another trainee network, SPARC. We hope that collaboration between trainee networks will develop over the next few years to improve both the scale and quality of research in our specialty.

Introduction


Some clinicians in the ICU use Bispectral Index (BIS) to titrate the depth of sedation, although its use has only been validated in neurologically healthy patients over one year of age [1] and seems to correlate poorly to the Sedation-Agitation Scale [2]. BIS monitoring may however be usefully employed as an adjunct to reduce the incidence of awareness in critically unwell patients in certain situations (e.g. patients requiring neuromuscular blockade and during invasive procedures such as tracheostomy insertion), or to minimize over-sedation, which is associated with poorer clinical outcomes [3].

 

The aim of the survey is to inform a non-commercial study.

 

The results have been analysed and submitted as a poster to the Wessex Intensive Care Society Meeting in June 2015. (Click to view)


Below is a table detailing response rates from the various trainee collaboratives.


                                                                        Group             Number of ICUs           Response


                                                                        STAR                         8                              8


                                                                        SHARC                      7                              7 


                                                                        ARNni                        5                              4


                                                                        SEARCH KSS           11                            6                    


                                                                        SWARM                     6                              6


                                                                        SPARC-ICM               12                           12


                                                                        OXICM                       10                            6


                                                                        Unknown                                                   3


                                                                        Total                          59                            52


                                                                        Response Rate                                         88.1%



References

1. Sadhasivam S, Ganesh A, Robison A, Kaye R, Watcha MF. Validation of the Bispectral Index Monitor for Measuring the Depth of Sedation in Children. Anesthesia & Analgesia. 2006;102(2):383–388. doi:10.1213/01.ANE.0000184115.57837.30.

2. Nasraway SA SA, Wu EC, Kelleher RM, Yasuda CM, Donnelly AM. How reliable is the Bispectral Index in critically ill patients? A prospective, comparative, single-blinded observer study. Critical Care Medicine. 2002;30(7):1483–1487.

3. Bigham C, Bigham S, Jones C. Does the bispectral index monitor have a role in intensive care? 1A03 2C04 3A13. Journal of Intensive Care Society. 2012;13(4):314–319.

 

Regional Project Lead

SWARM Committee in Collaboration with SPARC
 

Local Trust Project Lead

Derriford Hospital, Plymouth
Victoria Field
Royal Cornwall Hospital, Truro
Kathleen Mulcahy
Royal Devon & Exeter Hospital, Exeter
Lawrie Kidd
Musgrove Park Hospital, Taunton
Alexandra Hughes
Torbay Hospital, Torquay
Sandeep Kusre
North Devon District Hospital, Barnstaple
James Bickley

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