title: The Bispectral Index Scale: its use in the detection of brain death.
abstract: OBJECTIVE
  To evaluate the Bispectral Index Scale (BIS) monitor as a method of brain death (BD) detection.
  
  
  METHODS
  We performed an observational prospective study in an intensive care unit (ICU) of a university hospital of 19 patients hospitalized nonconsecutively in the ICU with serious neurologic pathology and evolution toward BD. A BIS monitor, XP model, and the sensor "BIS Quatro" were used to continuously record values: suppression ratio (SR), quality of the signal index, and electromyographic (EMG) activity.
  
  
  RESULTS
  The BD diagnosis was made through neurological clinical exploration and electroencephalogram (EEG) in all the cases. Additionally, transcranial Doppler was used in 13 patients. Coincident with clinical worsening, it was observed that there was a gradual decrease of the BIS value, together with a rise in the SR. In all the patients in which the BD diagnosis was confirmed, the BIS showed values of 0 and suppression rates of 100. Only one patient showed interferences, due to EMG activity, the same problem was detected when a conventional EEG was performing. After using a neuromuscular blocker, the values of BIS and SR were 0 and 100, respectively.
  
  
  CONCLUSIONS
  The BIS is a noninvasive, simple, and easy to interpret method. All the patients with BD diagnosis except for one had a BIS value of 0 and TS of 100, showing a perfect correlation with the other diagnostic methods. The BIS cannot be used on its own for the confirmation of the BD, but it is a useful tool to detect the beginning of brain herniation.
authors.affiliation: Intensive Care Unit, Central University Hospital of Asturias, Spain. dolores.escudero@sespa.princast.es
authors.forename: D
authors.initials: D
authors.lastname: Escudero
authors.forename: J
authors.initials: J
authors.lastname: Otero
authors.forename: G
authors.initials: G
authors.lastname: Muñiz
authors.forename: J A
authors.initials: JA
authors.lastname: Gonzalo
authors.forename: C
authors.initials: C
authors.lastname: Calleja
authors.forename: A
authors.initials: A
authors.lastname: González
authors.forename: A
authors.initials: A
authors.lastname: Martínez
authors.forename: D
authors.initials: D
authors.lastname: Parra
authors.forename: R
authors.initials: R
authors.lastname: Yano
authors.forename: F
authors.initials: F
authors.lastname: Taboada
mesh_terms: D001926:Brain Death / Q000175:diagnosis*; D004569:Electroencephalography; D004576:Electromyography; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic / Q000379:methods; D011446:Prospective Studies; D013030:Spain