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Published on: December 6, 2016
Assessing sedation in critically ill children by bispectral index, auditory-evoked potentials and clinical scales
Adelaida Lamas1, Jesús López-Herce, Luis Sancho
1Pediatric Intensive Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Insights
The bispectral index (BIS) and auditory-evoked potential index (AEP index) show moderate-to-good agreement with clinical sedation scales in critically ill children. These indices can help evaluate sedation levels, even in children with neuromuscular blockade.
Area of Science:
- Pediatric Critical Care Medicine
- Neurophysiology
- Anesthesiology
Background:
- Assessing sedation depth in critically ill children is crucial for patient management.
- Clinical sedation scales and electrophysiological monitoring tools are used, but their agreement needs further evaluation.
Purpose of the Study:
- To assess the correlation and agreement between the bispectral index (BIS), auditory-evoked potential index (AEP index), Ramsay scale (RS), and COMFORT scale (CS) for sedation monitoring in pediatric intensive care.
- To determine the utility of BIS and AEP index in critically ill children, including those with neuromuscular blockade.
Main Methods:
- Prospective observational study involving 77 critically ill, mechanically ventilated children.
- Simultaneous daily recordings of BIS, AEP index, RS, and CS for up to 5 days.
- Spearman rank correlation and Cohen's Kappa tests were used to analyze data; ROC analysis identified optimal BIS and AEP index values for sedation levels.
Main Results:
- Moderate-to-good correlation and agreement were found between BIS, AEP index, RS, and CS in children without neuromuscular blockade.
- No significant correlation was observed between these methods and heart rate, blood pressure, or sedative drug type/dose.
- Correlation was absent in paralyzed children, but BIS and AEP index showed potential for sedation assessment.
Conclusions:
- BIS and AEP index demonstrate moderate-to-good correlation and agreement with clinical sedation scales in non-paralyzed critically ill children.
- BIS and AEP index are potentially valuable tools for evaluating sedation levels in critically ill children, irrespective of neuromuscular blockade status.
Objective:
To evaluate the correlation and agreement between the bispectral index (BIS), middle latency auditory-evoked potential index (AEP index), Ramsay scale (RS) and COMFORT scale (CS) for evaluation of the level of sedation in critically ill children.
Design:
Prospective observational study.
Setting:
Pediatric critical care unit.
Patients:
Seventy-seven critically ill children receiving sedation and mechanical ventilation.
Measurements And Results:
Simultaneous recording of BIS, AEP index, RS and CS were performed once a day, for a maximum of 5 days. Two levels of sedation were categorized: light-moderate versus deep-very deep. Correlations between methods were determined using Spearman rank correlation test and the agreement using Cohen's Kappa test. The correlation and agreement between the four methods was moderate-to-good. Correlation was not found in paralyzed children. There was no correlation between the four methods and the heart rate or blood pressure, or with the type or dose of sedative medication. Receiver-operating characteristic (ROC) analysis revealed best discrimination between light-moderate and deep-very deep sedation at BIS and AEP index values of 63.5 and 33.5 when the level of sedation was classified by the RS, and at BIS and AEP index values of 67 and 37.5, respectively, when the level of sedation was classified by the CS.
Conclusion:
There is a moderate-to-good correlation and agreement of BIS and AEP index with the clinical scales in critically ill children without neuromuscular blockade. BIS and AEP index could be useful to evaluate the level of sedation in critically ill children with and without neuromuscular blockade.
