Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026
Bispectral Index and COMFORT B Score for Sedation in Mechanically Ventilated Children: A Prospective Observational Study.
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Jhunjhunwala Megha, Sachdev Anil, Gupta Suresh, Gupta Dhiren, Gupta Neeraj
Аннотация
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.
HOW TO CITE THIS ARTICLE: Jhunjhunwala M, Sachdev A, Gupta S, Gupta D, Gupta N. Bispectral Index and COMFORT B Score for Sedation in Mechanically Ventilated Children: A Prospective Observational Study. Indian J Crit Care Med 2026;30(4):305-310.
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.
HOW TO CITE THIS ARTICLE: Jhunjhunwala M, Sachdev A, Gupta S, Gupta D, Gupta N. Bispectral Index and COMFORT B Score for Sedation in Mechanically Ventilated Children: A Prospective Observational Study. Indian J Crit Care Med 2026;30(4):305-310.