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Updated: May 7, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The SNAP index does not correlate with the State Behavioral Scale in intubated and sedated children
Cecilia Thompson1, Veronika Shabanova, John S Giuliano
1Division of Critical Care Medicine, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Insights
The SNAP II electroencephalography device did not correlate with the State Behavioral Scale for monitoring sedation in critically ill children. Objective sedation assessment in pediatric intensive care units requires further investigation.
Area of Science:
- Pediatric Critical Care Medicine
- Neurophysiology
- Clinical Monitoring
Background:
- Appropriate sedation is crucial in pediatric critical care.
- Subjective scoring tools are traditionally used for sedation assessment.
- The SNAP II offers potential for objective sedation monitoring via electroencephalography.
Purpose of the Study:
- To evaluate the SNAP II as an objective method for monitoring sedation in critically ill pediatric patients.
- To compare the SNAP II (processed electroencephalography) with the State Behavioral Scale (SBS, subjective scoring).
- To determine if SNAP II correlates with SBS and reduces observer bias.
Main Methods:
- Prospective, observational study in a pediatric intensive care unit.
- Informed consent obtained from patients receiving mechanical ventilation and intravenous sedation.
- Blinded nurses assessed sedation using SBS while SNAP II indices were recorded.
- Pearson's correlation and covariance models were used to analyze data.
Main Results:
- Analysis of 417 paired data points from 15 patients showed no correlation between SNAP II indices and SBS scores.
- Covariance modeling, adjusting for covariates, also revealed no significant correlation.
- The SNAP II did not demonstrate a relationship with subjective sedation assessments in this cohort.
Conclusions:
- The SNAP II index does not correlate with SBS scores in critically ill pediatric patients.
- Current evidence does not support the use of SNAP II for measuring sedation levels in this population.
- Further research is needed to identify reliable objective methods for sedation monitoring in pediatric intensive care.
Background:
Ensuring appropriate levels of sedation for critically ill children is integral to pediatric critical care. Traditionally, clinicians have used subjective scoring tools to assess sedation levels. The SNAP II uses dual frequency processed electroencephalography to evaluate brain activity and may provide an objective assessment of sedation levels.
Objective:
This study attempts to find an objective method to monitor sedation in critically ill pediatric patients. We compared the SNAP II, a processed electroencephalography device, with the State Behavioral Scale (SBS), a subjective sedation scoring tool. We hypothesize that the SNAP II correlates with the SBS and has less observer bias.
Methods:
This was an IRB approved prospective, observational study. Patients receiving intravenous sedation while being mechanically ventilated were enrolled after informed consent. After the SNAP II monitoring electrodes were attached, blinded bedside nurses assessed sedation levels using the SBS. SNAP indices were collected and compared with SBS scores to determine correlation.
Results:
We compared 417 paired data points from 15 patients using Pearson's correlation and least squares means to determine correlation between the SBS and SNAP indices. No correlation was observed. Using covariance model patterning for repeated measures to adjust for covariates again showed no correlation.
Conclusion:
The SNAP index does not correlate with SBS scores in our pediatric intensive care unit (PICU). Its use cannot be recommended to measure levels of sedation in our population. Future research should continue to explore objective ways of measuring sedation in critically ill children.
