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Updated: May 19, 2026
Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
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.
Background And Aims:
The COMFORT B score is a validated method for the assessment of the level of sedation in children, but it has its limitations. The bispectral index (BIS) is an electroencephalogram (EEG)-based tool used to assess the level of consciousness. The primary objective was to evaluate agreement between the BIS and the COMFORT B score for sedation in children on mechanical ventilation (MV).
Patients And Methods:
This prospective, noninterventional study was conducted on 138 patients, aged >6 months, receiving MV in the pediatric intensive care unit (PICU). COMFORT B score and BIS were taken 30 minutes after initiation or dosage change of sedatives and then once every 8 hours for a maximum of 96 hours.
Results:
A total of 1,534 datasets were analyzed. Bispectral index values ranged from 11 to 89, while COMFORT B scores were between 6 and 28. The mean [± standard deviation (SD)] value for the BIS and COMFORT B scores was 54.4 ± 13.8 and 14 ± 4, respectively. Adequate sedation was recorded in 82.5 and 79.9% instances with BIS and COMFORT B scores, respectively. The correlation coefficient (r) of BIS and COMFORT B scores was 0.7. Overall agreement (kappa value) between the BIS and COMFORT B score was 0.642. A BIS score of 43 had 93% sensitivity and 70% specificity in differentiating oversedation from adequate sedation (AUROC 0.81). Similarly, a BIS value of 79 distinguished between adequate and undersedation (sensitivity 90%; specificity 98%; AUROC 0.966). The best AUROC (0.777) was observed in children with central nervous system (CNS) diseases, while the worst (0.54) occurred in patients with neuromuscular diseases.
Conclusion:
The BIS and COMFORT B scores have a good level of agreement in children, except in children with neuromuscular diseases.
How To Cite This Article:
Jhunjhunwala M, Sachdev A, Gupta S, Gupta D, Gupta N. Bispectral Index and COMFORT B Score for Sedation in Mechanically Ventilated Children: A Prospective Observational Study. Indian J Crit Care Med 2026;30(4):305-310.
