Bispectral Index and COMFORT B Score for Sedation in Mechanically Ventilated Children: A Prospective Observational Study

Background and aims:The COMFORT B score is a validated method for the assessment of the level of sedation in children, but it has its limitations.The bispectral index (BIS) is an electroencephalogram (EEG)-based tool used to assess the level of consciousness.The primary objective was to evaluate agreement between the BIS and the COMFORT B score for sedation in children on mechanical ventilation (MV).Patients and methods: This prospective, noninterventional study was conducted on 138 patients, aged >6 months, receiving MV in the pediatric intensive care unit (PICU).COMFORT B score and BIS were taken 30 minutes after initiation or dosage change of sedatives and then once every 8 hours for a maximum of 96 hours.Results: A total of 1,534 datasets were analyzed.Bispectral index values ranged from 11 to 89, while COMFORT B scores were between 6 and 28.The mean standard deviation (SD) value for the BIS and COMFORT B scores was 54.4 13.8 and 14 4, respectively.Adequate sedation was recorded in 82.5 and 79.9% instances with BIS and COMFORT B scores, respectively.The correlation coefficient (r) of BIS and COMFORT B scores was 0.7.Overall agreement (kappa value) between the BIS and COMFORT B score was 0.642.A BIS score of 43 had 93% sensitivity and 70% specificity in differentiating oversedation from adequate sedation (AUROC 0.81).Similarly, a BIS value of 79 distinguished between adequate and undersedation (sensitivity 90%; specificity 98%; AUROC 0.966).The best AUROC (0.777) was observed in children with central nervous system (CNS) diseases, while the worst (0.54) occurred in patients with neuromuscular diseases. Conclusion:The BIS and COMFORT B scores have a good level of agreement in children, except in children with neuromuscular diseases.