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BIS monitoring versus clinical assessment for sedation in mechanically ventilated adult patients in the intensive care unit and its impact on clinical outcomes and resource utilization

  1. Rajesh M Shetty1,*,
  2. Antonio Bellini2,
  3. Dhuleep S Wijayatilake3,
  4. Mark A Hamilton4,
  5. Rajesh Jain3,
  6. Gonzalo De La Cerda2,
  7. Sarah Stowell5,
  8. Sunil Karanth6

Editorial Group: Cochrane Anaesthesia, Critical and Emergency Care Group

Published Online: 5 AUG 2014

DOI: 10.1002/14651858.CD011240

How to Cite

Shetty RM, Bellini A, Wijayatilake DS, Hamilton MA, Jain R, De La Cerda G, Stowell S, Karanth S. BIS monitoring versus clinical assessment for sedation in mechanically ventilated adult patients in the intensive care unit and its impact on clinical outcomes and resource utilization (Protocol). Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No.: CD011240. DOI: 10.1002/14651858.CD011240.

Author Information

  1. 1

    Manipal Hospital, Multidisciplinary Intensive Care Unit, Bangalore, Karnataka, India

  2. 2

    Barking Havering and Redbridge University Hospitals NHS Trust, Intensive Care Unit, Romford, UK

  3. 3

    Barking Havering and Redbridge University Hospitals NHS Trust, Anaesthesia and Neurocritical care, Romford, UK

  4. 4

    St. George's Hospital, General Intensive Care Unit, London, UK

  5. 5

    StatAssured, Bishop's Stortford, UK

  6. 6

    Manipal Hospital, Multidisciplinary Critical Care Unit, Bangalore, Karnataka, India

*Rajesh M Shetty, Multidisciplinary Intensive Care Unit, Manipal Hospital, 98, Old Airport Road, Bangalore, Karnataka, 560017, India.

Publication History

  1. Publication Status: New
  2. Published Online: 5 AUG 2014



Additional references

Barr 2013
  • Barr J, Fraser G, Puntillo K, Ely E, Gèlinas C, Dasta J, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical Care Medicine 2013;41(1):263-306. [PUBMED: 23269131]
Carrasco 2000
Deogaonkar 2004
  • Deogaonkar A, Gupta R, DeGeorgia M, Sabharwal V, Gopakumaran B, Provencio JJ. Bispectral Index monitoring correlates with sedation scales in brain-injured patients. Critical Care Medicine 2004;32(12):2403-6. [PUBMED: 15599143]
Dewhurst 2000
  • Dewhurst AT, Chiverley-Williams S, Goldstone J. The change in bispectral index with stimulation indicates depth of sedation in intensive care. Critical Care 2000;4(Suppl 1):191. [PMC: 3333115]
Esteban 2002
  • Esteban A, Anzueto A, Frutos F, Alìa I, Brochard L, Stewart T, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation. A 28 day international study. JAMA 2002;287(3):345-55. [PUBMED: 11790214]
Fugate 2013
  • Fugate JE, Kalimullah EA, Hocker SE, Clark SL, Wijdicks EF, Rabinstein AA. Cefepime neurotoxicity in the intensive care unit: a cause of severe, under appreciated encephalopathy. Critical Care 2013;17(6):R264. [PUBMED: 24200036]
Gommers 2008
Guyatt 2008
Higgins 2002
  • Higgins JPT, Spiegelhalter DJ. Being sceptical about meta-analyses: a Bayesian perspective on magnesium trials in myocardial infarction. International Journal of Epidemiology 2002;31:96-104.
Higgins 2011
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011.
Hu 2013
  • Hu CF, Wang CC, Chen SJ, Perng CL, Yang HY, Fan HC. Prognostic values of a combination of intervals between respiratory illness and onset of neurological symptoms and elevated serum IgM titers in Mycoplasma pneumoniae encephalopathy. Journal of Microbilogy, Immunology and Infection = Wei mian yu gan ran za zhi 2013;S1684-1182(13):115. [PUBMED: 23968755]
Jackson 2010
  • Jackson D, Proudfoot C, Kann K, Walsh T. A systematic review of the impact of sedation in the ICU on resource use, costs and patient safety. Critical Care 2010;14:R59. [PUBMED: 20380720]
Jacobi 2002
  • Jacobi J, Fraser G, Coursin D, Riker R, Fontaine D, Wittbrodt E, et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Critical Care Medicine 2002;30(1):119-41. [PUBMED: 11902253]
Kaplan 2000
  • Kaplan LJ, Bailey H. Bispectral index (BIS) monitoring of ICU patients on continuous infusion of sedatives and paralytics reduces sedative drug utilization and cost. Critical Care 2000;4(Suppl 1):190. [PMC: 3333114]
Karamchandani 2010
  • Karamchandani K, Rewari V, Trikha A, Batra RK. Bispectral index correlates well with Richmond agitation sedation scale in mechanically ventilated critically ill patients. Journal of Anesthesia 2010;24(3):394-8. [PUBMED: 20225074]
Kollef 1998
  • Kollef M, Levy N, Ahrens T, Schaiff R, Prentice D, Sherman G. The use of continuous iv sedation is associated with prolongation of mechanical ventilation. Chest 1998;114(2):541-8. [PUBMED: 9726743]
Kress 2000
  • Kress J, Pohlman A, O'Connor M, Hall J. Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. New England Journal of Medicine 2000;342(20):1471-7. [PUBMED: 10816184]
LeBlanc 2006
Ma 2013
  • Ma L, Lin Z, Chen D. Wernicke encephalopathy following nutritional deficiency in a patient with multiple trauma. Anaesthesia and Intensive Care 2013;41(6):816-7. [PUBMED: 24180735]
Martin 2007
  • Martin J, Franck M, Sigel S, Weiss M, Spies C. Changes in sedation management in German intensive care units between 2002 and 2006: a national follow up survey. Critical Care 2007;11(6):R124-30. [PUBMED: 18062820]
Metnitz 2009
  • Metnitz P, Metnitz B, Moreno R, Bauer P, Del Sorbo L, Hoermann C, et al. Epidemiology of mechanical ventilation: analysis of the SAPS 3 database. Intensive Care Medicine 2009;35:816-25. [PUBMED: 19288079]
Patel 2012
  • Patel S, Kress J. Sedation and analgesia in the mechanically ventilated patient. American Journal of Respiratory and Critical Care Medicine 2012;185(5):486-97. [PUBMED: 22016443]
Punjasawadwong 2007
Reschreiter 2008
RevMan 5.2 [Computer program]
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Sedation Equipment & Supplies 2014
  • 186-0106E-Quad Sensor (4 Electrode Sensor). (accessed 2 June 2014).
Sessler 2008
  • Sessler C, Grap M, Ramsay M. Evaluating and monitoring analgesia and sedation in the intensive care unit. Critical Care 2008;12(Suppl 3):S2-14. [PUBMED: 18495053]
Singhal 2014
  • Singhal NS, Josephson SA. A practical approach to neurologic evaluation in the intensive care unit. Journal of Critical Care 2014;S0883-9441(14):00070-7. [PUBMED: 24636925]
Soliman 2001
  • Soliman H, Mélot C, Vincent JL. Sedative and analgesic practice in the intensive care unit: the results of a European survey. British Journal of Anaesthesia 2001;87(2):186-92. [PUBMED: 11493487]
Sonneville 2013
  • Sonneville R, Verdonk F, Rauturier C, Klein IF, Wolff M, Annane D, et al. Understanding brain dysfunction in sepsis. Annals of Intensive Care 2013;3(1):15. [PMCID: PMC3673822]
Stevens 2008
Yaman 2012
  • Yaman F, Ozcan N, Ozcan A, Kaymak C, Basar H. Assesment of correlation between Bispectral Index and four common sedation scales used in mechanically ventilated patients in ICU. European Review for Medical and Pharmacological Sciences 2012;16(5):660-6. [PUBMED: 22774408]
Zhao 2011
  • Zhao D, Xu Y, He W, Li T, He Y. A comparison of Bispectral Index and sedation agitation scale in guiding sedation therapy: a randomized controlled study in patients undergoing short term mechanical ventilation. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue 2011;23(4):220-3. [PUBMED: 21473824]
Ziaja 2013