Assessing sedation in the pediatric intensive care unit by using BIS and the COMFORT scale.

OBJECTIVE

To evaluate bispectral index technology in critically ill children and compare its performance to standard clinical assessment of sedation level.

DESIGN

Prospective convenience sample.

SETTING

Multidisciplinary 16-bed pediatric intensive care unit at a large, urban, university-affiliated children's hospital.

PATIENTS

Thirty-one pediatric intensive care unit patients requiring mechanical ventilation and sedation.

MEASUREMENTS AND MAIN RESULTS

Intubated, sedated, pediatric intensive care unit patients were evaluated for their level of sedation by using bispectral index (BIS) and the COMFORT scale twice daily for up to 5 days. The lowest and highest BIS measurements and their corresponding COMFORT scale measurements were selected from each subject. The mean BIS and COMFORT scale measurements were 62.4 +/- 2.6 and 18 +/- 0.6, respectively; however the individual measurements were only moderately correlated. The BIS values were categorized into very deep (<40), deep (41-60), moderate (61-80), and light (>80) levels of sedation. The corresponding COMFORT scale mean measurements in each category were 15.8 +/- 0.6, 16.2 +/- 0.6, 18.1 +/- 1.3, and 22.3 +/- 1.4 (R(2) =.89).

CONCLUSIONS

BIS measurements evaluated in clinically relevant ranges compare favorably with a standard assessment of the level of sedation. However, comparisons of BIS and COMFORT scale measurements at isolated moments during a prolonged pediatric intensive care unit course of sedation were less correlated. BIS may be best used to identify and prevent oversedation of patients in the pediatric intensive care unit.