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.