Applying BIS Monitoring To Evaluate The Patient With Mechanical Ventilation In Different Sedation Depth About The Stress Reaction

Objective:To discuss the effect of different BIS level to the stress response of mechanically ventilated patients in sedation by evaluating the range of cortisol, TNF-a and IL-8.And evaluate the correlation with BIS and the RASS and the Ramsay.Method:60mechanically ventilated over12hours critically ill patients who were admitted during September2011and April2012into the Department of Critical Care Medicine of CSU were divided into three groups according to the level of BIS-B1(40-60), B2(60-80) and B3(80-100), and all of them were sedated with propofol and (or) fentanyl. BIS were monitored and the level of cortisol, TNF-a and IL-8were recorded at the point of Oh,6h and12h after beginning sedation.BIS, RASS value and Ramsay value of the first3hours and the negative responses(such as MAP, incidence of restlessness after sucking sputum) were also recorded. Use SPSS17.0software and data processing, normal distribution with the qualitative material using chi-square test. Different groups of repeated measurements using variance analysis. The correlation of BIS and RASS and Ramsay was expressed as Spearman correlation coefficients(s). A P value of<0.05was considered statistically significant.Results:There were no statistical significance among the three groups in age, sex and APACHE II value(P>0.05).In calm6hours and12hours, B1group, B2group can respectively reduce stress response than B3group, and there were statistically significant difference (P<0.05),in addition in calm12hours B1group and B2group the comparison of the three indexes were statistically significant difference(P<0.05).However B1group reduce mean arterial pressure larger than other groups, there were statistical significance difference (P<0.05, P<0.01). Two of three groups comparison has a statistical significance (P<0.05) in sputum incidence, in B3group there was a higher sputum suction incidence than B2group, and B3group. On comparing BIS values for all patients with the corresponding Ramsay values and RASS values, there was a statistically highly significant correlation between BIS and Ramsay values (r=-0.724,P<0.00001),and RASS values (r=0.874,P<0.00001).For adequate sedation as judged by a Ramsay value of2to5,the BIS value range was found to be57-82.For adequate sedation as judged by a RASS value of-3to0,the BIS value range was found to be66-82.Conclusion:There are different effects of BIS to the stress response and the level of40to60can reduce cortisol, TNF-α,IL-8level, inhibit the stress response better to mechanically ventilated patents in sedation, has a lower adverse reaction, such as MAP and.Our results illustrate that BIS correlates well with RASS and Ramsay. BIS could reliably guide the level of sedation in mechanically ventilated critically ill patients.