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Published on: December 6, 2016
Bispectral Index and COMFORT B Score for Sedation in Mechanically Ventilated Children: A Prospective Observational
Megha Jhunjhunwala1, Anil Sachdev1, Suresh Gupta1
1Department of Pediatrics, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India.
Summary
The Bispectral Index (BIS) and COMFORT B score show good agreement for assessing sedation in pediatric patients on mechanical ventilation. However, this agreement is less reliable in children with neuromuscular diseases.
Area of Science:
- Pediatric Critical Care Medicine
- Neuroscience
- Anesthesiology
Background:
- The COMFORT B score is a validated tool for pediatric sedation assessment but has limitations.
- The Bispectral Index (BIS) is an electroencephalogram-based tool measuring consciousness levels.
Purpose of the Study:
- To evaluate the agreement between BIS and COMFORT B scores for sedation assessment in mechanically ventilated children.
Main Methods:
- A prospective, non-interventional study involving 138 pediatric patients (>6 months) on mechanical ventilation.
- BIS and COMFORT B scores were recorded at specified intervals for up to 96 hours.
Main Results:
- 1,534 datasets were analyzed, showing a correlation coefficient (r) of 0.7 and an overall agreement (kappa) of 0.642 between BIS and COMFORT B.
- BIS demonstrated good sensitivity and specificity in differentiating oversedation and adequate sedation.
- Agreement varied by condition, with the best performance in CNS diseases and the worst in neuromuscular diseases.
Conclusions:
- BIS and COMFORT B scores demonstrate good agreement in assessing sedation in pediatric patients.
- The agreement is notably reduced in children with neuromuscular diseases, suggesting caution in this population.
