Correlación entre análisis biespectral y escala COMFORT en la evaluación de sedación en la Unidad de Cuidados Intensivos Pediátricos

Abstract

Bispectral index and COMFORT scale melation in the evaluation of sedation on Paediatrics intensive Care Units Background: Sedation of critically-ill children in Paediatrics Intensive Care Units (PICU) is an essential component of patient care. The Bispectral Index (BIS) is a non-invasive electroencephalographic technique that measures continuously the hypnotic effects of various sedative agents. Objective: Evaluate Bispectral Index technology on ventilated patients in PICU and determine the degree of correlation with COMFORT Scale. Method: Prospective-blinded-observational study, where sedate children were evaluated in their sedation level by using BIS monitor and COMFORT Scale. BIS values were categorized in very deep (< 40), deep (41-60), moderate (61-80) and light (> 80) levels of sedation. Results: 9 patients were enrolled in the study, obtaining 180 valid-paired observations of BIS values and COMFORT Scale scores. The median COMFORT Scale and BIS values were 17 (range 11-29) and 48 (range 18-90), respectively. The correlation coefficient between BIS and COMFORT Scale in the individual measurements was good (R = 0.74). When BIS measurements were categorized in light, moderate, deep and very deep sedation levels, the BIS and COMFORT Scale measurements were highly correlated (R = 0.92). 72% of BIS observations were above adequate sedation levels. Conclusions: There is a good correlation between BIS and COMFORT Scale. BIS may be a useful tool in sedation assessment on ventilated paediatric patients, identifying excessive sedation in PICU.

Discomfort of the critically ill paediatric patient and correlated variables

“…8,9 The most commonly used strategy for managing the comfort of critically ill paediatric patients is sedation and analgesia. 3,10,11 The optimal use of analgosedation allows for invasive procedures to be carried out safely by permitting synchronisation and patient tolerance of mechanical ventilation (MV), 11 preventing accidental extubation and reducing both metabolic 12 and oxygen consumption in the case of shock. 13 Pharmacological therapy to control pain, induce comfort, and produce tolerance of an apparently hostile environment in critically ill patients is based on substances such as sedatives/hypnotics and analgesics.…”

Monitorización mediante índice biespectral de niños sometidos a procedimientos invasivos bajo sedoanalgesia con propofol y fentanilo en cuidados intensivos pediátricos

“…La sobresedación en pacientes paralizados es algo bastante común, y por otra parte las escalas de sedación basadas en parámetros fisiológicos y menos aún los conductuales, no son útiles para valorar la profundidad de la sedación107 . De hecho, se ha visto que la escala más recomendada en este tipo de pacientes (COMFORT) se correlaciona con el BIS en pacientes en ventilación mecánica106,108,109 , e incluso, es inferior al BIS para prevenir la sobresedación59 .Por todo ello el BIS en estos casos es útil90 , aunque aún es difícil determinar el rango en el que hay que manejarse cuando un niño en ventilación mecánica se encuentra paralizado. En principio, se estima que ese rango óptimo en pacientes pediátricos podría estar entre 50 y 70110 .…”