2.50
Hdl Handle:
http://hdl.handle.net/10755/157115
Category:
Abstract
Type:
Presentation
Title:
Use of the Bispectral Index Monitor (BIS) when Extubating Cardiac Surgery Patients
Author(s):
Henry, Linda; Speir, Alan; Martin, Lisa; Anderson, Jennifer; Halpin, Linda; Ad, Niv; Hunt, Sharon; White, Janice
Author Details:
Linda Henry, Inova Heart and Vascular Institute, Falls Church, Virginia, USA, email: lhenry6@cox.net; Alan Speir; Lisa Martin; Jennifer Anderson; Linda Halpin; Niv Ad; Sharon Hunt; Janice White
Abstract:
PURPOSE: Frequently, open heart patients are intubated on arrival to the ICU, where the nurse assumes responsibility for extubation. Nurses rely on experience and an extubation protocol to determine a patient's readiness to extubate. The Bispectral (BIS) monitor assesses a patient's level of mental arousal and awareness while anesthetized or in the post-operative phase while sedated. This study set out to determine if the BIS might facilitate waking and earlier extubation of the open heart patient. BACKGROUND: Data indicate rapid extubation following cardiac surgery reduces morbidity and mortality. BIS monitoring has been used to assess sedation in patients undergoing procedures while receiving anesthesia or for continuously sedated and neurologically compromised ICU patients. In these situations, the goal is a state of unawareness to prevent recall. Little data exists on using the BIS monitor in the arousal phase following surgical procedures to facilitate the extubation of intubated patients. METHODS: A matched case control study; thirty prospective, stable patients returning to the ICU with a BIS monitor were matched 1:1 to pre BIS patients on age, gender, type of surgery, status on arrival in ICU and surgeon. The data collected included: age, gender, type of surgery, temperature, pH, CO2 on arrival/extubation, total amount of Propofol and pain medication received prior to extubation, BIS and RASS scores. Descriptive statistics were used to describe the groups. T tests were used with the continuous data and chi- square with categorical data to assess differences between the groups. Multiple regression was used to determine which variables were predictive of time to extubation. RESULTS: 25 BIS patients were matched on selected criteria to 25 pre BIS patients (N=50). The majority of the patients were male (78%), received coronary artery bypass surgery (90%) with an average age of 63.6 years and were extubated an average of 5 hours 50 minutes post surgery. Chi square tests determined no differences between groups for gender and type of surgery (p>.05). T tests determined no differences between groups for age, amount of Propofol and pain medication received and time to extubation (p>.05) A significant regression equation was found (F(4,52)=12.79, p < .001), with an R2 of .496. Total Propofol, total hydromorphone and age were significant predictors of time to extubation. CONCLUSIONS: The BIS monitor did not appear to facilitate waking and earlier extubation for this group of patients at our institution. Efforts to reduce the time to extubation may need to focus on reviewing current protocols for the use of Propofol and pain medication prior to extubation in the stable post cardiac surgery patient.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date:
2009
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
New Orleans, Louisiana, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleUse of the Bispectral Index Monitor (BIS) when Extubating Cardiac Surgery Patientsen_GB
dc.contributor.authorHenry, Lindaen_GB
dc.contributor.authorSpeir, Alanen_GB
dc.contributor.authorMartin, Lisaen_GB
dc.contributor.authorAnderson, Jenniferen_GB
dc.contributor.authorHalpin, Lindaen_GB
dc.contributor.authorAd, Niven_GB
dc.contributor.authorHunt, Sharonen_GB
dc.contributor.authorWhite, Janiceen_GB
dc.author.detailsLinda Henry, Inova Heart and Vascular Institute, Falls Church, Virginia, USA, email: lhenry6@cox.net; Alan Speir; Lisa Martin; Jennifer Anderson; Linda Halpin; Niv Ad; Sharon Hunt; Janice Whiteen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157115-
dc.description.abstractPURPOSE: Frequently, open heart patients are intubated on arrival to the ICU, where the nurse assumes responsibility for extubation. Nurses rely on experience and an extubation protocol to determine a patient's readiness to extubate. The Bispectral (BIS) monitor assesses a patient's level of mental arousal and awareness while anesthetized or in the post-operative phase while sedated. This study set out to determine if the BIS might facilitate waking and earlier extubation of the open heart patient. BACKGROUND: Data indicate rapid extubation following cardiac surgery reduces morbidity and mortality. BIS monitoring has been used to assess sedation in patients undergoing procedures while receiving anesthesia or for continuously sedated and neurologically compromised ICU patients. In these situations, the goal is a state of unawareness to prevent recall. Little data exists on using the BIS monitor in the arousal phase following surgical procedures to facilitate the extubation of intubated patients. METHODS: A matched case control study; thirty prospective, stable patients returning to the ICU with a BIS monitor were matched 1:1 to pre BIS patients on age, gender, type of surgery, status on arrival in ICU and surgeon. The data collected included: age, gender, type of surgery, temperature, pH, CO2 on arrival/extubation, total amount of Propofol and pain medication received prior to extubation, BIS and RASS scores. Descriptive statistics were used to describe the groups. T tests were used with the continuous data and chi- square with categorical data to assess differences between the groups. Multiple regression was used to determine which variables were predictive of time to extubation. RESULTS: 25 BIS patients were matched on selected criteria to 25 pre BIS patients (N=50). The majority of the patients were male (78%), received coronary artery bypass surgery (90%) with an average age of 63.6 years and were extubated an average of 5 hours 50 minutes post surgery. Chi square tests determined no differences between groups for gender and type of surgery (p>.05). T tests determined no differences between groups for age, amount of Propofol and pain medication received and time to extubation (p>.05) A significant regression equation was found (F(4,52)=12.79, p < .001), with an R2 of .496. Total Propofol, total hydromorphone and age were significant predictors of time to extubation. CONCLUSIONS: The BIS monitor did not appear to facilitate waking and earlier extubation for this group of patients at our institution. Efforts to reduce the time to extubation may need to focus on reviewing current protocols for the use of Propofol and pain medication prior to extubation in the stable post cardiac surgery patient.en_GB
dc.date.available2011-10-26T19:26:04Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:26:04Z-
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.conference.date2009en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationNew Orleans, Louisiana, USAen_GB
dc.identifier.citation2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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