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Assessing sedation in the pediatric intensive care unit by using BIS and the COMFORT scale
Noreen Crain1, Anthony Slonim, Murray M Pollack
1Pediatric Critical Care Division, University of Virginia Health Sciences Center, University of Virginia School of Medicine, Charlottesville, VA, USA.
Insights
Bispectral index (BIS) technology shows promise in assessing sedation levels in critically ill children. While BIS correlates with the COMFORT scale, it may be most effective in preventing oversedation in the pediatric intensive care unit.
Area of Science:
- Critical Care Medicine
- Pediatric Intensive Care
- Neurophysiology
Background:
- Sedation management is crucial for mechanically ventilated patients in the pediatric intensive care unit (PICU).
- Accurate assessment of sedation depth is essential to prevent complications associated with oversedation or undersedation.
Purpose of the Study:
- To evaluate the utility of bispectral index (BIS) technology for assessing sedation in critically ill children.
- To compare BIS performance against standard clinical sedation assessment using the COMFORT scale.
Main Methods:
- A prospective study involving 31 mechanically ventilated and sedated patients in a multidisciplinary PICU.
- Bispectral index (BIS) and COMFORT scale measurements were taken twice daily for up to 5 days.
- BIS values were categorized (deep, moderate, light sedation) and correlated with COMFORT scale scores.
Main Results:
- Mean BIS and COMFORT scale measurements were 62.4 and 18, respectively.
- Individual BIS and COMFORT scale measurements showed only moderate correlation.
- BIS categories demonstrated varying mean COMFORT scale scores, with a strong correlation (R² = .89) between categorized BIS levels and COMFORT scores.
Conclusions:
- Bispectral index (BIS) technology provides a favorable comparison to standard sedation assessment in clinically relevant ranges.
- Isolated BIS and COMFORT scale measurements during prolonged PICU stays showed less correlation.
- BIS may be a valuable tool for identifying and preventing oversedation in PICU patients.
Objective:
To evaluate bispectral index technology in critically ill children and compare its performance to standard clinical assessment of sedation level.
Design:
Prospective convenience sample.
Setting:
Multidisciplinary 16-bed pediatric intensive care unit at a large, urban, university-affiliated children's hospital.
Patients:
Thirty-one pediatric intensive care unit patients requiring mechanical ventilation and sedation.
Measurements And Main Results:
Intubated, sedated, pediatric intensive care unit patients were evaluated for their level of sedation by using bispectral index (BIS) and the COMFORT scale twice daily for up to 5 days. The lowest and highest BIS measurements and their corresponding COMFORT scale measurements were selected from each subject. The mean BIS and COMFORT scale measurements were 62.4 +/- 2.6 and 18 +/- 0.6, respectively; however the individual measurements were only moderately correlated. The BIS values were categorized into very deep (<40), deep (41-60), moderate (61-80), and light (>80) levels of sedation. The corresponding COMFORT scale mean measurements in each category were 15.8 +/- 0.6, 16.2 +/- 0.6, 18.1 +/- 1.3, and 22.3 +/- 1.4 (R(2) =.89).
Conclusions:
BIS measurements evaluated in clinically relevant ranges compare favorably with a standard assessment of the level of sedation. However, comparisons of BIS and COMFORT scale measurements at isolated moments during a prolonged pediatric intensive care unit course of sedation were less correlated. BIS may be best used to identify and prevent oversedation of patients in the pediatric intensive care unit.