Inadequate Sedation During Therapeutic Paralysis: Use of Bispectral Index in Critically Ill Patients

摘要

Background Patients receiving therapeutic paralysis may experience inadequate sedation due to intrinsic limitations of behavioral sedation assessment. Bispectral index (BIS?) provides an objective measure of sedation; however, the role of BIS? is not well defined in intensive care unit (ICU) patients on neuromuscular blocking agents (NMBA). Objective The aim of this study was to delineate the relationship between BIS? and level of sedation for critically ill patients during therapeutic paralysis. Methods This was a retrospective observational study conducted in ICU patients receiving continuous infusion NMBA and BIS? monitoring. The primary endpoint was the correlation of BIS?? Results Thirty-one patients were included in the analysis. Three of these patients (9.6?%) were inadequately sedated upon emergence from paralysis; that is, restless or agitated (RASS +1 to +2). We did not observe a correlation between BIS? and RASS upon emergence from paralysis ( r =?0.27, p =?0.14). The sensitivity of BIS?? Conclusion These results suggest that 1 in 10 critically ill patients receiving therapeutic paralysis may be inadequately sedated. BIS? monitoring may serve as a useful adjunctive measure of sedation in critically ill patients receiving therapeutic paralysis.