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Bundled Bispectral Index Monitoring and Sedation During Paralysis in Acute Respiratory Distress Syndrome.
Abraham, Sunitha; Lussier, Bethany L.
  • Abraham S; Sunitha Abraham is Nurse Practitioner, Neurointensive Care Unit, Parkland Memorial Hospital, Dallas, Texas.
  • Lussier BL; Bethany L. Lussier is Assistant Professor of Pulmonary and Critical Care, Neurocritical Care in the Department of Medicine and the Department of Neurology and Neurosurgery, Parkland Memorial Hospital, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, CS-08417, Dallas, TX 75370 (Bethany.Lussier@utsouthwestern.edu).
AACN Adv Crit Care ; 33(3): 253-261, 2022 Sep 15.
Article in English | MEDLINE | ID: covidwho-2024642
ABSTRACT

BACKGROUND:

Clinical assessments of depth of sedation are insufficient for patients undergoing neuromuscular blockade during treatment of acute respiratory distress syndrome (ARDS). This quality initiative was aimed to augment objective assessment and improve sedation during therapeutic paralysis using the bispectral index (BIS).

METHODS:

This quality improvement intervention provided education and subsequent implementation of a BIS monitoring and sedation/analgesia bundle in a large, urban, safety-net intensive care unit. After the intervention, a retrospective review of the first 70 admissions with ARDS assessed use and documented sedation changes in response to BIS.

RESULTS:

Therapeutic neuromuscular blockade was initiated for 58 of 70 patients (82.8%) with ARDS, of whom 43 (74%) had BIS monitoring and 29.3% had bundled BIS sedation-titration orders. Explicit documentation of sedation titration in response to BIS values occurred in 27 (62.8%) of those with BIS recordings.

CONCLUSIONS:

BIS sedation/analgesia bundled order sets are underused, but education and access to BIS monitoring led to high use of monitoring alone and subsequent sedation changes.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Neuromuscular Blockade / Anesthesia Type of study: Diagnostic study / Observational study / Prognostic study Limits: Humans Language: English Journal: AACN Adv Crit Care Journal subject: Nursing / Critical Care Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Neuromuscular Blockade / Anesthesia Type of study: Diagnostic study / Observational study / Prognostic study Limits: Humans Language: English Journal: AACN Adv Crit Care Journal subject: Nursing / Critical Care Year: 2022 Document Type: Article