Considerations for use in the ICU
- Reliance on the BIS alone for sedative management is not recommended
- Clinical judgement should always be used when interpreting the BIS in conjunction with other available clinical signs
- BIS readings should be interpreted over time and in response to stimulation, and in the context of patient status and treatment plan
- Movement may occur with low BIS values
- Movement (EMG) may indicate inadequate analgesic level
- Artifacts and poor signal quality may lead to unreliable BIS values. Potential artifacts may be caused by poor skin contact, muscle activity or rigidity, head and body motion, sustained eye movements, improper sensor placement or skin preparation, and unusual or excessive interference
- BIS values should be interpreted cautiously in patients with known neurological disorders, in those taking psychoactive medications and in children less than 1 year old
- Natural sleep cycles may affect the hypnotic level
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