NONINVASIVE MONITORING OF CRITICALLY ILL CHILD

nmcickapak

BISPECTRAL INDEX (BIS) MONITORING IN CRITICALLY ILL CHILD

Elif Ergin1
Eylem Ulaş Saz2

1Ege University, Faculty of Medicine, Department of Pediatric Emergency, İzmir, Türkiye
2Ege University, Faculty of Medicine, Department of Pediatric Emergency, İzmir, Türkiye

Ergin E, Ulaş Saz E. Bispectral Index (BIS) Monitoring in Critically Ill Child. In: Bal A, editor. Non Invasive Monitoring of Critically Ill Child. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.107-114.

ABSTRACT

Sedation management in critically ill children presents unique challenges in accurately assessing se- dation depth. In this context, Bispectral Index (BIS) monitoring has emerged as a valuable tool that quantitatively measures sedation depth and provides predictions about brain activity based on elec- troencephalogram (EEG) data. This section aims to explore the application, effectiveness, and limita- tions of BIS monitoring in pediatric critical care, emphasizing its importance in optimizing sedation management and minimizing complications, while also discussing other areas of use and synthesizing findings from various studies to provide a comprehensive overview. BIS predicts the level of brain activity by mathematically analyzing the frequencies of waves in EEG signals. First introduced in 1992 by Aspect Medical Systems, BIS evaluates the phase relationships of a single-channel EEG signal measured from the patient’s forehead and provides a score ranging from 0 to 100. The BIS algorithm begins with the digitization and preprocessing of the EEG signal and includes various artifact detec- tion algorithms. Providing adequate sedation and analgesia to critically ill children is an essential requirement in the pediatric intensive care unit. Inadequate sedation can increase anxiety and pain, disrupting the patient’s synchronization with the ventilator. BIS helps prevent these issues by providing a quantitative measure of sedation levels. Although it has been noted that BIS values may decrease in patients undergoing neuromuscular blockade (NMB), which could misleadingly affect the assessment of sedation levels, safe applications have also been reported in this patient group. However, the limita- tions of BIS and the potential for the sensor to cause skin damage should be considered. Additionally, BIS monitoring is also used in the detection of pediatric brain death. Confirmatory tests are required for the diagnosis of brain death, but BIS is practical in providing information during the detection phase. Furthermore, monitoring BIS during the interhospital transport of critically ill children may effectively reduce complications experienced during transport. In conclusion, BIS monitoring represents a signifi- cant advancement in sedation management for critically ill children. Its ability to provide an objective, real-time assessment of sedation depth enhances patient safety and improves the quality of care. In the future, further research and development are needed to increase the effectiveness of BIS.

Keywords: Consciousness monitors; Deep sedation; Critical illness; Intensive care units pediatric; Brain death; Transportation of patients

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