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Background: Patients receiving therapeutic paralysis may experience inadequate sedation due to intrinsic limitations of behavioral sedation assessment. Bispectral index (BISTM) provides an objective measure of sedation; however, the role of BISTM is not well defined in intensive care unit (ICU) patients on neuromuscular blocking agents (NMBA).

Objective: The aim of this study was to delineate the relationship between BISTM and level of sedation for critically ill patients during therapeutic paralysis.

Methods: This was a retrospective observational study conducted in ICU patients receiving continuous infusion NMBA and BISTM monitoring. The primary endpoint was the correlation of BISTM\60 during therapeutic paralysis with a Richmond Agitation Sedation Score (RASS) of -4 to -5 (i.e., deep or unarousable sedation) at the time of emergence from therapeutic paralysis.

Results: Thirty-one patients were included in the analysis. Three of these patients (9.6 %) were inadequately sedated upon emergence from paralysis; that is, restless or agitated (RASS ?1 to ?2). We did not observe a correlation between BISTM and RASS upon emergence from paralysis (r = 0.27, p = 0.14). The sensitivity of BISTM\60 in predicting deep sedation (RASS -5 to -4) was 100 % (95 % confidence interval [CI] 0–100) with a positive predictive value of 35.7 %. The sensitivity and positive predictive value of BISTM\60 in predicting light sedation or deeper (RASS -5 to -2) was 92.9 % (95 %CI 83.3–100) and 92.9 %, respectively.

Conclusion: These results suggest that 1 in 10 critically ill patients receiving therapeutic paralysis may be inadequately sedated. BISTM monitoring may serve as a useful adjunctive measure of sedation in critically ill patients receiving therapeutic paralysis.

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Originally published in Drugs: Real World Outcomes, 3(2), 201-208. Licensed under CC BY-NC 4.0. doi:10.1007/s40801-016-0076-3