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

Inclusion Criteria: * Age between 1 month and 18 years * Receiving invasive mechanical ventilation * Expected to require sedation for ≥24 hours * Hemodynamically stable at enrollment * BIS monitoring electrode placement feasible Exclusion Criteria: * Use of neuromuscular blocking agents at enrollment * Mechanical ventilation expected to last \<24 hours * Severe hemodynamic instability requiring escalating vasoactive support * Known neurological disorders that prevent reliable BIS interpretation (e.g., severe encephalopathy, epileptic burst suppression) * Facial burns or skin conditions preventing BIS electrode placement * Decision for palliative/comfort care only