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The use of the bispectral index in the detection of pain in mechanically ventilated adults in the intensive care unit: a review of the literature.

Coleman RM, Tousignant-Laflamme Y, Ouellet P, Parenteau-Goudreault É, Cogan J, Bourgault P - Pain Res Manag (2014)

Bottom Line: The EMBASE, Medline, CINAHL and PsycINFO databases were searched for studies published between 1996 and 2013 that evaluated the use of the bispectral index in assessing pain.Most studies conclude that nociceptive stimulation causes a significant increase in the bispectral index and revealed the importance of controlling certain confounding variables such as the level of sedation.Further studies are needed to clearly demonstrate the relationship between nociceptive stimuli and the bispectral index, as well as the specificity of the bispectral index in detecting pain.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Pain assessment is an immense challenge for clinicians, especially in the context of the intensive care unit, where the patient is often unable to communicate verbally. Several methods of pain assessment have been proposed to assess pain in this environment. These include both behavioural observation scales and evaluation of physiological measurements such as heart rate and blood pressure. Although numerous validation studies pertaining to behavioural observation scales have been published, several limitations associated with using these measures for pain assessment remain. Over the past few years, researchers have been interested in the use of the bispectral index monitoring system as a proxy for the evaluation of encephalography readings to assess the level of anesthesia and, potentially, analgesia.

Objectives: To synthesize the main studies exploring the use of the bispectral index monitoring system for pain assessment, to guide future research in adults under sedation in the intensive care unit.

Method: The EMBASE, Medline, CINAHL and PsycINFO databases were searched for studies published between 1996 and 2013 that evaluated the use of the bispectral index in assessing pain.

Results: Most studies conclude that nociceptive stimulation causes a significant increase in the bispectral index and revealed the importance of controlling certain confounding variables such as the level of sedation.

Discussion: Further studies are needed to clearly demonstrate the relationship between nociceptive stimuli and the bispectral index, as well as the specificity of the bispectral index in detecting pain.

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Related in: MedlinePlus

Selection of articles flow chart diagram. ICU Intensive care unit; OR Operating room
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f1-prm-20-e33: Selection of articles flow chart diagram. ICU Intensive care unit; OR Operating room

Mentions: Four databases were searched for the present review of the literature: EMBASE, Medline, CINAHL and PsycINFO. The present review aims to evaluate the use of the BIS monitor in assessing pain. The keywords used were: pain, painful procedure, nociception or analgesia, bispectral index, operating room and intensive care. The search was limited to articles published in English or French between 1996 and 2013. This electronic database search strategy yielded 243 records. From the 243 studies obtained, 17 duplicate records were identified and removed, leaving 226 unique articles. These articles were thereafter screened for eligibility determination and inclusion criteria, resulting in the removal of 212 articles that did not involve human subjects, painful procedures, nociception or analgesia in the operating room (OR) or ICU setting. All articles remaining after this process (n=14) were selected and analyzed in the present review by the first author (RMC) (Figure 1). These studies focused on the use of the BIS monitor to assess pain or nociception and were divided into two main groups: studies conducted in the OR (n=9 studies) and those conducted in the ICU (n=5 studies).


The use of the bispectral index in the detection of pain in mechanically ventilated adults in the intensive care unit: a review of the literature.

Coleman RM, Tousignant-Laflamme Y, Ouellet P, Parenteau-Goudreault É, Cogan J, Bourgault P - Pain Res Manag (2014)

Selection of articles flow chart diagram. ICU Intensive care unit; OR Operating room
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325898&req=5

f1-prm-20-e33: Selection of articles flow chart diagram. ICU Intensive care unit; OR Operating room
Mentions: Four databases were searched for the present review of the literature: EMBASE, Medline, CINAHL and PsycINFO. The present review aims to evaluate the use of the BIS monitor in assessing pain. The keywords used were: pain, painful procedure, nociception or analgesia, bispectral index, operating room and intensive care. The search was limited to articles published in English or French between 1996 and 2013. This electronic database search strategy yielded 243 records. From the 243 studies obtained, 17 duplicate records were identified and removed, leaving 226 unique articles. These articles were thereafter screened for eligibility determination and inclusion criteria, resulting in the removal of 212 articles that did not involve human subjects, painful procedures, nociception or analgesia in the operating room (OR) or ICU setting. All articles remaining after this process (n=14) were selected and analyzed in the present review by the first author (RMC) (Figure 1). These studies focused on the use of the BIS monitor to assess pain or nociception and were divided into two main groups: studies conducted in the OR (n=9 studies) and those conducted in the ICU (n=5 studies).

Bottom Line: The EMBASE, Medline, CINAHL and PsycINFO databases were searched for studies published between 1996 and 2013 that evaluated the use of the bispectral index in assessing pain.Most studies conclude that nociceptive stimulation causes a significant increase in the bispectral index and revealed the importance of controlling certain confounding variables such as the level of sedation.Further studies are needed to clearly demonstrate the relationship between nociceptive stimuli and the bispectral index, as well as the specificity of the bispectral index in detecting pain.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Pain assessment is an immense challenge for clinicians, especially in the context of the intensive care unit, where the patient is often unable to communicate verbally. Several methods of pain assessment have been proposed to assess pain in this environment. These include both behavioural observation scales and evaluation of physiological measurements such as heart rate and blood pressure. Although numerous validation studies pertaining to behavioural observation scales have been published, several limitations associated with using these measures for pain assessment remain. Over the past few years, researchers have been interested in the use of the bispectral index monitoring system as a proxy for the evaluation of encephalography readings to assess the level of anesthesia and, potentially, analgesia.

Objectives: To synthesize the main studies exploring the use of the bispectral index monitoring system for pain assessment, to guide future research in adults under sedation in the intensive care unit.

Method: The EMBASE, Medline, CINAHL and PsycINFO databases were searched for studies published between 1996 and 2013 that evaluated the use of the bispectral index in assessing pain.

Results: Most studies conclude that nociceptive stimulation causes a significant increase in the bispectral index and revealed the importance of controlling certain confounding variables such as the level of sedation.

Discussion: Further studies are needed to clearly demonstrate the relationship between nociceptive stimuli and the bispectral index, as well as the specificity of the bispectral index in detecting pain.

Show MeSH
Related in: MedlinePlus