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ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 2  |  Page : 77-83

A comparative study between the bispectral index and the clinical score in the evaluation of sedation level in critically ill, mechanically ventilated patients


1 Department of Critical Care Medicine, Alexandria University, Alexandria, Egypt
2 Department of Critical Care Medicine, Cairo University, Cairo, Egypt

Correspondence Address:
Amr Abouelela
ICU Department, PO Box 946, KFMMC, Dhahran
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/roaic.roaic_104_16

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Background The 2013 sedation guidelines from the Society of Critical Care Medicine recommend using sedation scales to optimize sedation therapy. However, scales such as the Richmond Agitation–Sedation Scale (RASS) require subjective evaluation that may lead to variability in measurement and consequent clinical actions. The bispectral index (BIS) is an objective measure of the level of consciousness that is often used as anesthetic tool, and its use has broadened to include the ICU. Published data are still insufficient to warrant routine use of the BIS in critically ill patients. Aim The aim of this study was to compare the RASS with the BIS in measuring the level of sedation. Patients and methods This was a prospective study performed on 60 critically ill, adult, mechanically ventilated patients receiving sedation infusion. The BIS monitor was attached continuously to all patients for 3 days, and the digital readings were recorded every 4 h. The RASS was assessed and recorded at the same time. Statistical analyses were performed to assess the correlation between the two used modalities over time. Patients receiving muscle relaxants were excluded from the study. In addition, patients with head injuries or patients known to have any focal brain disease or abnormal electrical brain activities such as epilepsy were excluded. Results A total of 1080 readings comparing the RASS with the BIS were obtained from the 60 patients included in the present study over 3 days. No serious side-effects due to the BIS electrodes placed for 3 days were recorded. The correlation between RASS scores and BIS values was positive and statistically significant. The overall correlation scores in the 3 days were as follows − r=0.652, P less than 0.001 on day 1; r=0.685, P less than 0.001 on day 2; and r=0.686, P less than 0.001 on day 3. The correlation was statistically significant with the use of midazolam but not with dexmedetomidine. Conclusion An overall statistically significant, positive correlation between the BIS and the RASS was present. The BIS can be used as an adjunct for scoring.


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