Awareness and bispectral index (BIS) monitoring in mechanically ventilated patients in the emergency department and intensive care unit: A systematic review protocol

Ryan D. Pappal, Brian W. Roberts, Winston Winkler, Lauren H. Yaegar, Robert J. Stephens, Brian M. Fuller

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Introduction Accidental awareness with recall is one of the most feared complications for patients undergoing general anaesthesia and can lead to post-traumatic stress disorder in up to 70% of patients experiencing it. To reduce the incidence of awareness with recall, the bispectral index monitor is recommended for patients receiving total intravenous anaesthetics, especially those receiving neuromuscular blockers. While extensive investigation into awareness and bispectral index monitoring has occurred for operating room patients, this has not extended to other clinical arenas where sedated and mechanically ventilated patients are cared for, namely the intensive care unit and emergency department. The purpose of this systematic review is to assess the world's literature to determine the incidence of awareness with paralysis in mechanically ventilated patients and the impact of bispectral index monitoring for reducing this complication. Methods and analysis Randomised trials and non-randomised studies are eligible for inclusion. With aid from a medical librarian, an electronic search will include Ovid Medline,, Scopus, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials. To find data published in abstract form, literature from professional society conferences (2010-2019) will be manually searched. Two authors will independently review search results and consensus will be reached with assistance from a third author, as needed. Heterogeneity and publication bias will be assessed and reported. If possible and appropriate, a meta-analysis of the data will be conducted for quantitative data analysis. Ethics and dissemination The proposed systematic review does not require ethical approval, as it is conducted at the study level and does not involve individual patient-level data. Results will be disseminated by data sharing via academically established means, presentation at local and national scientific meetings and publication as a peer-reviewed manuscript. PROSPERO registration number The protocol has been submitted to International Prospective Register of Systematic Reviews and is awaiting registration.

Original languageEnglish
Article numbere034673
JournalBMJ Open
Issue number3
StatePublished - Mar 4 2020


  • accident & emergency medicine
  • adult intensive & critical care
  • adult intensive & critical care


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