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Online ISSN 1827-1596
Beliz BILGILI 1, Juan C. MONTOYA 2, A. Joseph LAYON 3, Andrea L. BERGER, H. Lester KIRCHNER, Leena K. GUPTA, David S. GLOSS
1 Anesthesiology and Critical Care Medicine, Marmara University Teaching and Education Hospital, Istanbul, Turkey; 2 Department of General Internal Medicine, The Geisinger Clinic, Danville, PA, USA; 3 Department of Critical Care Medicine, The Geisinger Clinic, Danville, PA, USA; 4 Center for Health Research, Division of Medicine, The Geisinger Clinic, Danville, PA, USA; 5 Critical Care Medicine, The Geisinger Clinic, Danville, PA, USA; 6 Regional Medical Center of San Jose, San Jose, CA, USA; 7 Department of Neurology, The Geisinger Clinic, Danville, PA, USA
BACKGROUND: The ideal level of sedation in the ICU is an ongoing source of scrutiny. At higher levels of sedation, the current scoring systems are not ideal. BIS may be able to improve both. We evaluated literature on effectiveness of BIS monitoring in sedated mechanically ventilated (MV) ICU patients compared to clinical sedation scores (CSS).
METHODS: For this systematic review, full text articles were searched in OVID, MEDLINE, EMBASE, and Cochrane databases from 1986 – 2014. Additional studies were identified searching bibliographies/abstracts from national/international Critical Care Medicine conferences and references from searched articles retrieved. Search terms were: ‘Clinical sedation scale, Bi-spectral Index, Mechanical ventilation, Intensive care Unit’. Included were prospective, randomized and non-randomized studies comparing BIS monitoring with any CSS in MV adult (>18 yr old) ICU patients. Studies were graded for quality of evidence based on bias as established by the GRADE guidelines. Additional sources of bias were examined.
RESULTS: There were five studies which met inclusion criteria. All five studies were either unclear or high risk for blinding of participants and blinding of outcome assessment. All papers had at least one source of additional high risk, or unclear/unstated.
CONCLUSIONS: BIS monitoring in the mechanically ventilated ICU patient may decrease sedative drug dose, recall, and time to wake-up. The studies suggesting this are severely limited methodologically. BIS, when compared to subjective CSSs, is not, at this time, clearly indicated. An appropriately powered randomized, controlled study is needed to determine if this monitoring modality is of use on the ICU.