title: Bispectral index versus COMFORT score to determine the level of sedation in paediatric intensive care unit patients: a prospective study.
abstract: BACKGROUND
  Most clinicians give sedatives and analgesics according to their professional experience and the patient's estimated need for sedation. However, this approach is prone to error. Inadequate monitoring of sedation and analgesia may contribute to adverse outcomes and complications. With this in mind, data obtained continuously using nonstimulating methods such as bispectral index (BIS) may have benefits in comparison with clinical monitoring of sedation. The aim of this prospective observational trial was to evaluate the use of electroencephalographic (EEG) BIS for monitoring sedation in paediatric intensive care unit (PICU) patients.
  
  
  METHODS
  Forty paediatric patients (<18 years) were sedated for mechanical ventilation in a cardiac surgical and general PICU. In each paediatric patient BIS and COMFORT score were obtained. The study protocol did not influence ongoing PICU therapy. BIS and corresponding COMFORT score were collected three times for each patient. Measurements with the best starting EEG impedances were analyzed further. Deep sedation was defined as a COMFORT score between 8 and 16, and light sedation as a score between 17 and 26. Biometric and physiological data, and Pediatric Risk of Mortality III scores were also recorded.
  
  
  RESULTS
  There was a good correlation (Spearman's rho 0.651; P = 0.001) between BIS and COMFORT score in the presence of deep sedation and low starting impedance. Receiver operating characteristic (ROC) analysis revealed best discrimination between deep and light sedation at a BIS level of 83.
  
  
  CONCLUSIONS
  In the presence of deep sedation, BIS correlated satisfactorily with COMFORT score results if low EEG impedances were guaranteed.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine [corrected], Campus Benjamin Franklin, Charité University Hospital Berlin, Berlin, Germany. andreas.triltsch@charite.de
authors.forename: Andreas E
authors.initials: AE
authors.lastname: Triltsch
authors.forename: Grit
authors.initials: G
authors.lastname: Nestmann
authors.forename: Helmut
authors.initials: H
authors.lastname: Orawa
authors.forename: Maryam
authors.initials: M
authors.lastname: Moshirzadeh
authors.forename: Michael
authors.initials: M
authors.lastname: Sander
authors.forename: Joachim
authors.initials: J
authors.lastname: Grosse
authors.forename: Arka
authors.initials: A
authors.lastname: Genähr
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Konertz
authors.forename: Claudia D
authors.initials: CD
authors.lastname: Spies
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000145:classification*; D004569:Electroencephalography / Q000379:methods; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016015:Logistic Models; D011446:Prospective Studies; D012372:ROC Curve