Combining Objective and Subjective Sedation Assessment Tools (COST_2)

The purpose of this study is to determine if the use of a device called the BIS monitor in addition to the Richmond Agitation Sedation Scale will give better assessment of a subject's level of sedation.

Patients in the intensive care unit (ICU) who require a ventilator to help them breathe also require sedation in order to keep them comfortable and prevent injury. The national guidelines for sedation management include a daily interruption of sedation performed once each morning. To determine the amount of sedation needed, the current standard practice is to use a system called the Richmond Agitation-Sedation Scale (RASS). The patient is stimulated by calling their name or by tapping their shoulder until the patient's responses indicate that a satisfactory level of sedation has been achieved. The purpose of this study is to determine if the use of a device called the BIS monitor in addition to the RASS will give better assessment of a subject's level of sedation. The BIS monitor is a sensor strip taped to the forehead and attached to a device that reads electrical activity from the brain. It is approved by the U.S. Food and Drug Administration (FDA) for monitoring patients under sedation.

Mechanical ventilation, Human, conscious sedation, bispectral index, monitoring, critical care, propofol

Participants in this arm will receive sedation assessment with the RASS scale augmented with Bispectral Index (BIS) Monitor

Participants will receive sedation assessment only using the RASS scale which is the standard of care at our institution

The mean amount of propofol used on each patient while the patient was in the ICU and receiving mechanical ventilation.

Inclusion Criteria: patient in the ICU continuous IV sedation with propofol midazolam or dexmedetomidine age > 18 expected to require mechanical ventilation for >=48 hours Exclusion Criteria: prisoners no available space on forehead continuous electroencephalography(EEG) monitoring bifrontal brain injury barbiturate coma therapy known hypersensitivity to study medications high risk for ethanol (ETOH) withdrawal resuscitation from cardiac arrest without recovery of mental status moribund clinical state (death expected within 48 hours)