bispectral index monitoting - british columbia 脑电双频指数监测-不列颠哥伦比亚省

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1、ICUSKILLSUPDATEFebruary/March2007ByDianneBrownICUSkillsUpdateTheoryandHandsOnPracticeBispectralIndexMonitoringBISPECTRALINDEXMONITOTINGBISPECTRALINDEXMONITORINGThebispectralindex(BIS)isafairlyrecenttechnologyusedtomeasuretheeffectsofanestheticsandsedativesonthebrainandconsciousnessUsesacomplexmat

2、hematicalalgorithmbasedupondescriptiveEEGparametersfromthefrontalcortextosuggestvariouslevelsofsedationBISPECTRALINDEXMONITORINGAsensor,placedonthepatient’sforehead,sendsrawEEGwaveformstothemonitor,wheretheyareanalyzedandaBISindexiscalculatedThisvaluerangesfrom100(completelyawake)to0(isoelectricE

3、EG)BISPECTRALINDEXMONITORINGBISPECTRALINDEXMONITORINGUnderstandingtherelationshipbetweenBISandEEGWhenBISmonitoringisinitiated,asensorisplacedacrossthepatient’sforeheadpermanufacturer’srecommendationstodetectonechannelofEEGactivityTheEEGsignalisfilteredanddigitalizedTheEEGstate(frequency/amplitude

4、)iscalculatedandassociatedwiththelevelofsedation,arousaloranesthesiaUnderstandingtherelationshipbetweenBISandEEGTheBISvalueisasinglenumberbasedontheprevious15secondsofEEGdataandisupdatedfrequentlyTheBISmonitorprovidesasinglechannelofanEEGtracingfromtherightorleftfrontal-temporalmontageelectrodepl

5、acementICUSedation:ABipolarChallengeOver-sedationPatientunabletoparticipateincareDelayedweaning↑Ventilator-associatedpneumonia↑Unnecessarytesting↑ICUandhospitallengthofstay↑CostsUnder-sedationAnxiety,agitation↑Cost,nursingtime↑Useofneuromuscularblockingagents↑Riskofrecall/awarenessofunpleasantev

6、ents↑UnintendedmedicaldeviceremovalPotentialIndicationsforBISMonitoringUsewithneuromuscularblockade:BISmonitoringmayhelptoidentifypatientsatriskofawareness,recallandpainwhenparalyzedUseofBISvaluestoguidesedationandanalgesiaTitratingsedation/analgesiainpatientsreceivingcontrolledventilationAvoidin

7、gextremesofunderandoversedationTitrationofmedicationsformedication-inducedcomaFactorsaffectingtheBISvalueSedation:decreaseinBISvalueAnalgesia:decreaseinBISvalueNeuromuscularblockingagents:decreaseinBISvaluerelatedtoatt