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Published on: December 6, 2016
Assessing sedation in a pediatric intensive care unit using Comfort Behavioural Scale and Bispectral Index: these
A Amigoni1, E Mozzo, L Brugnaro
1Department of Pediatrics, University of Padua, Padua, Italy. amigoni@pediatria.unipd.it
Insights
Monitoring sedation in critically ill children using Comfort Behavioural Scale (CBS) and Bispectral Index (BIS) revealed BIS was better at predicting shorter hospital stays. Over-sedation risks were identified.
Area of Science:
- Pediatric Critical Care Medicine
- Neuroscience
- Clinical Monitoring
Background:
- Optimizing analgesic and sedative therapy is crucial for pediatric critical care patients.
- Assessing patient comfort and sedation levels is essential for effective treatment.
Purpose of the Study:
- To measure sedation levels in a Pediatric Intensive Care Unit (PICU) using the Comfort Behavioural Scale (CBS) and Bispectral Index (BIS).
- To evaluate the agreement between CBS and BIS in assessing sedation.
- To analyze the correlation between adequate sedation and patient outcomes.
Main Methods:
- A prospective observational study involving 46 mechanically ventilated pediatric patients.
- Monitoring sedation at baseline and during tracheal suctioning.
- Assessing outcomes including ventilation duration, PICU stay, and sedative therapy length.
Main Results:
- Adequate sedation was achieved in 26% (doctor CBS), 34.8% (nurse CBS), and 73.9% (BIS) of patients at baseline.
- During stimulation, adequately sedated patients increased to 78.2% per CBS.
- Agreement between CBS and BIS was weak; BIS monitoring correlated with shorter PICU stay and sedative duration.
Conclusions:
- Data suggest a risk of oversedation in critically ill children.
- Differences exist between CBS and BIS in detecting light oversedation.
- BIS-identified excessive sedation was linked to longer hospitalization and sedative administration.
Background:
The aim of this paper was to monitor comfort in pediatric critical ill patients which is necessary to adequate analgesic and sedative therapy. The primary objective of this prospective observational study was to measure the level of sedation in a Pediatric Intensive Care Unit (PICU) of a tertiary care Hospital, using Comfort Behavioural Scale (CBS) and Bispectral Index (BIS), evaluating the agreement between these tools; secondly we analyzed the correlation of an adequate level of sedation and patient's outcome.
Methods:
We enrolled 46 patients, mechanically ventilated for almost 12 hours, monitored at a basal level and during a stimulus (tracheal suctioning). As outcome variables we analyzed: length of ventilation and PICU stay, duration of sedative therapy and weaning, time between beginning of sedative administration and start of weaning, presence of infection.
Results:
Twenty-six percent (doctor CBS score), 34.8% (nurse CBS score) and 73.9% (BIS) of our population were found adequately sedated; none state of undersedation was reported. During the stimulus the percentage of adequately sedated patients according to CBS became 78.2%. CBS level of agreement versus BIS was weak. No significative difference was found between doctor and nurse CBS score. Length of PICU stay and duration of sedative administered were significant shorter in patients adequately sedated at Bispectral Index monitoring; no outcome variable resulted significant looking at CBS score.
Conclusion:
Our data support the risk of oversedation in critically ill patients and the difference between CBS and BIS, especially in evaluating light oversedation state. The presence of an excessive level of sedation evaluated by BIS was associated with duration of hospitalization and sedative administration.
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