Bundled Bispectral Index Monitoring and Sedation During Paralysis in Acute Respiratory Distress Syndrome.

IF 2 Q2 NURSING

AACN Advanced Critical Care Pub Date : 2022-09-15 DOI:10.4037/aacnacc2022240

Sunitha Abraham, Bethany L Lussier

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引用次数: 0

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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急性呼吸窘迫综合征瘫痪期间捆绑双谱指数监测与镇静。

背景:在急性呼吸窘迫综合征(ARDS)治疗过程中，对神经肌肉阻滞患者镇静深度的临床评估不足。这项质量倡议旨在利用双谱指数(BIS)增强客观评估和改善治疗性瘫痪期间的镇静作用。方法:这种质量改善干预提供了教育和随后实施BIS监测和镇静/镇痛束在大型，城市，安全网重症监护病房。干预后，对前70例ARDS入院患者进行回顾性审查，评估使用情况并记录镇静变化对BIS的反应。结果:70例ARDS患者中有58例(82.8%)采用了治疗性神经肌肉阻断，其中43例(74%)有BIS监测，29.3%有BIS镇静滴定单。有BIS记录的患者中，有27人(62.8%)明确记录了镇静滴定对BIS值的反应。结论:BIS镇静/镇痛捆绑单套使用不足，但教育和获得BIS监测导致单独监测和随后镇静变化的高使用率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

AACN Advanced Critical Care NURSING-

CiteScore

2.10

自引率

4.50%

发文量

期刊介绍： AACN Advanced Critical Care is a quarterly, peer-reviewed publication of in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue includes a topic-based symposium, feature articles, and columns of interest to critical care and progressive care clinicians. AACN Advanced Critical Care contains concisely written, practical information for immediate use and future reference. Continuing education units are available for selected articles in each issue. AACN Advanced Critical Care is an official publication of the American Association of Critical-Care Nurses.