The impact of Bispectral Index monitoring on sedation administration in mechanically ventilated patients

IntroductionAccidental awareness with recall is one of the most feared complications for patients undergoing general anaesthesia and can lead to post-traumatic stress disorder in up to 70% of patients experiencing it. To reduce the incidence of awareness with recall, the bispectral index monitor is recommended for patients receiving total intravenous anaesthetics, especially those receiving neuromuscular blockers. While extensive investigation into awareness and bispectral index monitoring has occurred for operating room patients, this has not extended to other clinical arenas where sedated and mechanically ventilated patients are cared for, namely the intensive care unit and emergency department. The purpose of this systematic review is to assess the world’s literature to determine the incidence of awareness with paralysis in mechanically ventilated patients and the impact of bispectral index monitoring for reducing this complication.Methods and analysisRandomised trials and non-randomised studies are eligible for inclusion. With aid from a medical librarian, an electronic search will include Ovid Medline, Embase.com, Scopus, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. To find data published in abstract form, literature from professional society conferences (2010–2019) will be manually searched. Two authors will independently review search results and consensus will be reached with assistance from a third author, as needed. Heterogeneity and publication bias will be assessed and reported. If possible and appropriate, a meta-analysis of the data will be conducted for quantitative data analysis.Ethics and disseminationThe proposed systematic review does not require ethical approval, as it is conducted at the study level and does not involve individual patient-level data. Results will be disseminated by data sharing via academically established means, presentation at local and national scientific meetings and publication as a peer-reviewed manuscript.PROSPERO registration numberThe protocol has been submitted to International Prospective Register of Systematic Reviews and is awaiting registration.

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The impact of cardiac dysfunction on acute respiratory distress syndrome and mortality in mechanically ventilated patients with severe sepsis and septic shock: An observational study

Journal of Critical Care ◽

10.1016/j.jcrc.2014.07.027 ◽

2015 ◽

Vol 30 (1) ◽

pp. 65-70 ◽

Cited By ~ 9

Author(s):

Brian M. Fuller ◽

Nicholas M. Mohr ◽

Thomas J. Graetz ◽

Isaac P. Lynch ◽

Matthew Dettmer ◽

...

Keyword(s):

Septic Shock ◽

Acute Respiratory Distress Syndrome ◽

Severe Sepsis ◽

Cardiac Dysfunction ◽

Distress Syndrome ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Sepsis And Septic Shock ◽

The Impact ◽

Ventilated Patients

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Use of bispectral index to monitor the depth of sedation in mechanically ventilated patients in the prehospital setting

Emergency Medicine Journal ◽

10.1136/emermed-2012-202238 ◽

2013 ◽

Vol 31 (8) ◽

pp. 669-672

Author(s):

François-Xavier Duchateau ◽

Monique Saunier ◽

Béatrice Larroque ◽

Julien Josseaume ◽

Tobias Gauss ◽

...

Keyword(s):

Bispectral Index ◽

Prehospital Setting ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

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Bispectral Index Can Reliably Detect Deep Sedation in Mechanically Ventilated Patients

Anesthesia & Analgesia ◽

10.1213/ane.0000000000001786 ◽

2017 ◽

Vol 125 (1) ◽

pp. 176-183 ◽

Cited By ~ 11

Author(s):

Zhu-Heng Wang ◽

Han Chen ◽

Yan-Lin Yang ◽

Zhong-Hua Shi ◽

Qing-Hua Guo ◽

...

Keyword(s):

Bispectral Index ◽

Deep Sedation ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Ventilated Patients

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Impact of Serum Phosphate in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock

Journal of Intensive Care Medicine ◽

10.1177/0885066618762753 ◽

2018 ◽

Vol 35 (5) ◽

pp. 485-493 ◽

Cited By ~ 10

Author(s):

Christopher J. Miller ◽

Bruce A. Doepker ◽

Andrew N. Springer ◽

Matthew C. Exline ◽

Gary Phillips ◽

...

Keyword(s):

Septic Shock ◽

Mechanical Ventilation ◽

Severe Sepsis ◽

Clinical Outcomes ◽

Serum Phosphate ◽

Mechanically Ventilated ◽

Mechanically Ventilated Patients ◽

Sepsis And Septic Shock ◽

The Impact ◽

Ventilated Patients

Background: Hypo- and hyperphosphatemia are common in severe sepsis and septic shock. Published outcome data in patients with phosphate derangements primarily focus on hypophosphatemia and the general critically ill population. This study aimed to determine the impact of serum phosphate on clinical outcomes in patients with severe sepsis and septic shock. Methods: A retrospective cohort analysis of adult mechanically ventilated patients with severe sepsis or septic shock was performed. Patients were randomly selected from an internal intensive care unit (ICU) database at an academic medical center in the United States and screened for inclusion and exclusion criteria. Time-weighted phosphate was calculated using all phosphate measurements obtained during ICU admission. The associations between time-weighted phosphate and duration of mechanical ventilation, 28-day mortality, and ICU and hospital length of stay were evaluated using linear or logistic regression as appropriate. Results: One-hundred ninety-seven patients were evaluated: 33 were categorized as hypophosphatemia, 123 as normophosphatemia, and 41 as hyperphosphatemia. Patients with time-weighted hyperphosphatemia had a higher Simplified Acute Physiology Score III score and incidence of septic shock. Significantly higher rates of 28-day mortality were observed among those with time-weighted phosphate levels above 3.5 mg/dL. However, both time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. For every 0.5 mg/dL increase in time-weighted phosphate referent values from 4.0 to 6.0, the duration of mechanical ventilation decreased by 8% to 26%. For every 0.5 mg/dL decrease in time-weighted phosphate referent values from 3.0 to 1.0, significant decreases in duration of mechanical ventilation ranged from 14% to 41%. Conclusion: Time-weighted hyperphosphatemia may be associated with increased mortality in mechanically ventilated patients with severe sepsis or septic shock. However, time-weighted hypo- and hyperphosphatemia were associated with decreased duration of mechanical ventilation. Future studies should further describe the impact of hypo- and hyperphosphatemia on clinical outcomes among critically ill patients with severe sepsis or septic shock.

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