Escudero D, Otero J, Muñiz G, Gonzalo J A, Calleja C, González A, Martínez A, Parra D, Yano R, Taboada F
Intensive Care Unit, Central University Hospital of Asturias, Spain.
Transplant Proc. 2005 Nov;37(9):3661-3. doi: 10.1016/j.transproceed.2005.08.054.
To evaluate the Bispectral Index Scale (BIS) monitor as a method of brain death (BD) detection.
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.
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.
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.
评估脑电双频指数（BIS）监测仪作为检测脑死亡（BD）的一种方法。
我们在一所大学医院的重症监护病房（ICU）进行了一项观察性前瞻性研究，研究对象为19例非连续入住ICU且患有严重神经病理学疾病并逐渐发展为脑死亡的患者。使用XP型号的BIS监测仪及“BIS Quatro”传感器持续记录以下数值：抑制率（SR）、信号指数质量和肌电图（EMG）活动。
所有病例均通过神经临床检查和脑电图（EEG）做出脑死亡诊断。此外，13例患者使用了经颅多普勒检查。随着临床病情恶化，观察到BIS值逐渐下降，同时SR升高。在所有确诊为脑死亡的患者中，BIS值均为0，抑制率为100%。仅1例患者因EMG活动出现干扰，在进行常规脑电图检查时也检测到了同样的问题。使用神经肌肉阻滞剂后，BIS和SR值分别为0和100。
BIS是一种无创、简单且易于解读的方法。除1例患者外，所有诊断为脑死亡的患者BIS值均为0，抑制率为100%，与其他诊断方法显示出完美的相关性。BIS不能单独用于确诊脑死亡，但它是检测脑疝开始的有用工具。
