The use of bispectral index to monitor barbiturate coma in severely brain-injured patients with refractory intracranial hypertension.

BACKGROUND

Barbiturate therapy in severely traumatic brain-injured (TBI) patients is usually monitored by an electroencephalogram (EEG) with burst-suppression pattern as a target. The Bispectral Index (BIS) is derived from EEG and considers cortical silence. We sought to determine whether a BIS range could predict a specific burst-suppression pattern.

METHODS

Eleven TBI patients treated with barbiturate were included prospectively. EEG was recorded daily for 1 h. Every 5 min, the number of bursts and the suppression ratio (suppression ratio from EEG [SR(EEG)]: percentage of last 60 s in cortical silence) was calculated for 1 min on the raw EEG and compared to concomitant data from the BIS-XP (BIS and suppression ratio [SR(BIS)]). The optimal level of barbiturate coma was defined as 2-5 bursts/min in the EEG. A BIS range predictive of optimal level was determined from all data and its accuracy was studied for each examination.

RESULTS

Agreement between SR(EEG) and SR(BIS) was high (interclass correlation coefficient 0.94 [95% confidence interval: 0.90-0.96]). There was a significant association between SR(EEG) and BIS. Significant disagreements were observed in some examinations. The best accuracy to predict optimal pattern was obtained with a BIS range from 6 to 15.

CONCLUSION

The relationship between BIS and SR(EEG) was high in TBI patients treated with barbiturates. The rate of barbiturate infusion might be decreased if BIS is <6 or increased if BIS is >15. Correspondence between BIS and suppression pattern should periodically be checked by observation of the EEG analogical signal (as displayed by BIS-XP).