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PEDIATRIC ANESTHESIA

The Correlation of the Bispectral Index Monitor with Clinical Sedation Scores During Mechanical Ventilation in the Pediatric Intensive Care Unit

John W. Berkenbosch, MD^*, Christopher R. Fichter, MSc^*, and Joseph D. Tobias, MD^*

Departments of *Child Health, Anesthesiology, and the Division of Pediatric Critical Care/Pediatric Anesthesiology, University of Missouri-Columbia, Columbia, Missouri

Address correspondence to John W. Berkenbosch, MD, The Department of Child Health, University of Missouri, One Hospital Dr., Columbia, MO 65212. Address e-mail to berkenboschj{at}health.missouri.edu

In patients who are mechanically ventilated in the pediatric intensive care unit (PICU), sedative and/or analgesic medications are routinely provided and titrated to effect based on clinical assessment of the patient. The bispectral index (BIS) monitor uses a modified electroencephalogram to quantify the effects of central nervous system-acting drugs on the level of consciousness. To evaluate the usefulness of the BIS monitor to predict clinical sedation levels in the PICU, we compared BIS values with simultaneously obtained clinical sedation scores in 24 mechanically ventilated pediatric patients aged 5.7 ± 6.1 yr. For each sedation scale used, the BIS value correlated with increasing depth of sedation (P < 0.0001) and was independent of the drug(s) used for sedation. To differentiate adequate from inadequate sedation, a BIS value <70 had a sensitivity of 0.87–0.89 and a positive predictive value of 0.68–0.84. To differentiate adequate from excessive sedation, a BIS value <50 had a sensitivity of 0.67–0.75 and a positive predictive value of 0.07–0.52. We conclude that the BIS monitor may be a useful adjunct for the assessment of sedation in PICU patients.

IMPLICATIONS: We demonstrate the usefulness of the bispectral index monitor for assessing sedation in pediatric intensive care unit patients. The bispectral index monitor correlated with clinically assessed sedation levels and was useful for differentiating adequate from inadequate sedation, which would be of value when the clinical examination is unavailable.

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