Background. Many critically ill patients are given sedatives andparalytics to facilitate aeromedical transport. Bispectral index (BIS) monitoring is a computer-derived electroencephalography (EEG) analog currently used to monitor the level of awareness of sedated patients. It gives a score of 1100, with 1 representing no brain function and100 representing a completely alert patient. Objective. To evaluate whether critically ill patients are adequately sedated during aeromedical transport. Methods. This was a prospective, observational study of a convenience sample of critically ill patients transported by helicopter. All intubated patients who received sedatives and/or paralytics to facilitate transport were eligible for enrollment by the attending clinician. Prior to liftoff, a BIS sensor was applied to the patient's forehead. Minimum, maximum, andmean BIS index scores were recorded every minute during transport. Results. Forty-seven patients (57 male) were enrolled, with a median age of 60 years (interquartile range [IQR] 1881, range 14 to 86 years). The median duration of monitoring was 15.0 minutes (IQR 6.026.0, range 2 to 33). The median BIS score was 54.6 (IQR 38.667.3, range 28 to 89.5). Only two patients (4.3, 95 confidence interval [CI] 0.5 to 14.8) had at least one BIS score greater than 85, the accepted threshold for recall. Conclusion. These results suggest that patients are adequately sedated during air medical transport.
Bibliographical noteFunding Information:
This study was conducted in association with Life Link III, a critical care medical transport company based in Minneapolis, Minnesota. The feasibility portion of the study was conducted between December 2003 and February 2004. The observational portion of this study was a prospective, convenience sample of critically ill patients transported by helicopter between August 2004 and May 2006. Inclusion criteria for the study included all critcally ill intubated adult patients (scene and interfacility) transported by Life Link III who received sedatives and/or paralytics to facilitate transport. This study was approved by the Human Subjects Research Committee of Hennepin County Medical Center.
- Air ambulance
- BIS monitor
- Conscious sedation
- Sedation in HEMS