Nurse-Led BIS-Guided Sedation Protocol in Pediatric Intensive Care

This prospective, randomized (1:1) controlled trial was conducted in two tertiary PICUs in Turkey, including mechanically ventilated children aged 1 month to 18 years requiring continuous sedation. Patients were randomly assigned to: Intervention Group: Nurse-led sedation titration using BIS values (target: light sedation 60-80, deep sedation 45-60) combined with SBS scores under physician supervision. Nurses received structured theoretical and practical training before trial initiation. Control Group: Standard sedation protocol based solely on clinical sedation assessment without BIS-guided titration (BIS monitoring available but not used for titration). Primary Outcome: Percentage and duration of time spent outside the target BIS range Total sedative medication dose (mg/kg/day equivalents) Secondary Outcomes: PICU length of stay Mechanical ventilation duration Withdrawal symptoms (WAT-1 score) Results showed significantly reduced BIS out-of-target time, lower sedative drug exposure (midazolam, ketamine, dexmedetomidine), reduced withdrawal scores, and shorter PICU stay in the intervention group.