[Bispectral index monitoring during intrahospital transport].
OBJECTIVE
Risk of morbidity and mortality increases for critically ill patients during transfers within the hospital. Such patients often require sedation, and suboptimal sedation is associated with hypertension, tachycardia, and ventilator dyssynchrony. The aim of this study was to assess level of sedation as indicated by monitoring of the bispectral (BIS) index during intrahospital transport of critical patients.


METHODS
Thirty patients who required transport to the critical care unit within the hospital were studied prospectively. We recorded time in transport, the agent used for sedation and the dosage, the BIS index, mean arterial pressure (MAP), and heart rate before starting transport and upon arrival at the critical care unit. The data were recorded by an observer who was not assigned to patient care.


RESULTS
The mean (SD) transport time was 13.9 (4.2) minutes. Midazolam was used in 26 patients and propofol in 4. Ten patients were given a bolus dose of cisatracurium before transfer started. Significant increases were observed in the BIS index (from 47 to 78, (P < .001), MAP (from 73 to 91 mmHg, P < .001), and heart rate (from 72 to 97 beats/min, P < .001) between the moment of starting transport and arrival at the critical care unit. Changes in the BIS index correlated significantly with changes in heart rate (r = 0.418, P = .024) but not with changes in MAP (r = 0.249, P = .19).


CONCLUSIONS
Monitoring the BIS index during intrahospital transport of sedated, mechanically ventilated patients may be useful for detecting inadequate sedation.
Hernández-Gancedo
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Servicio de Anestesiología, Reanimación y Unidad del Dolor, Hospital General Universitario La Paz, Madrid. mhgancedo@hotmail.com
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Criado
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D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D016292:Procedural Sedation; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data; D004569:Electroencephalography / Q000379:methods*; D004576:Electromyography / Q000379:methods*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D007362:Intensive Care Units; D008874:Midazolam / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D008991:Monitoring, Physiologic / Q000379:methods* / Q000706:statistics & numerical data; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D010360:Patient Transfer; D011446:Prospective Studies; D012121:Respiration, Artificial; D013997:Time Factors
D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium; D008874:Midazolam