TY - JOUR
T1 - Assessing the predictive value of the bispectral index vs patient state index on clinical assessment of sedation in postoperative cardiac surgery patients
AU - Adesanya, Adebola O.
AU - Rosero, Eric
AU - Wyrick, Christine
AU - Wall, Michael H.
AU - Joshi, Girish P.
N1 - Funding Information:
This work was supported in part by an unrestricted grant from Hospira Inc and the Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX.
Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2009/9
Y1 - 2009/9
N2 - Purpose: To compare the depth of sedation determined by Ramsay sedation scale (RSS) with electroencephalogram-based bispectral index (BIS) and patient state index (PSI). Materials and Methods: Fifty mechanically ventilated cardiac surgical patients undergoing propofol and morphine sedation were assessed hourly for up to 6 hours or until tracheal extubation using the BIS, PSI, and RSS. Correlation between RSS, BIS, and PSI was determined, as well as the interrater reliability of RSS, BIS, and PSI. κ statistics was used to further evaluate the agreement between BIS and PSI. Results: There was positive correlation between BIS and PSI values (ρ = 0.731, P < .001). The average weighted κ coefficient was .40 between the BIS and PSI, 0.28 between the RSS and BIS, and 0.16 between the RSS and PSI. Intraclass correlation was consistently higher between the BIS and PSI at all time intervals during the study. Logistic regression modeling over study duration showed that the BIS was consistently better at predicting oversedation (area under the curve, 0.92) than the PSI (area under the curve, 0.78). A comparison of BIS and PSI receiver operating characteristic curves showed that the BIS monitor was a better predictor of oversedation compared with the PSI (P = .02). Conclusions: There is significant positive correlation between the BIS and PSI but poor correlation and poor test agreement between the RSS and BIS as well as RSS and PSI. The BIS is a better predictor of oversedation compared with the PSI. There was no significant difference between the BIS and PSI with respect to the prediction of undersedation.
AB - Purpose: To compare the depth of sedation determined by Ramsay sedation scale (RSS) with electroencephalogram-based bispectral index (BIS) and patient state index (PSI). Materials and Methods: Fifty mechanically ventilated cardiac surgical patients undergoing propofol and morphine sedation were assessed hourly for up to 6 hours or until tracheal extubation using the BIS, PSI, and RSS. Correlation between RSS, BIS, and PSI was determined, as well as the interrater reliability of RSS, BIS, and PSI. κ statistics was used to further evaluate the agreement between BIS and PSI. Results: There was positive correlation between BIS and PSI values (ρ = 0.731, P < .001). The average weighted κ coefficient was .40 between the BIS and PSI, 0.28 between the RSS and BIS, and 0.16 between the RSS and PSI. Intraclass correlation was consistently higher between the BIS and PSI at all time intervals during the study. Logistic regression modeling over study duration showed that the BIS was consistently better at predicting oversedation (area under the curve, 0.92) than the PSI (area under the curve, 0.78). A comparison of BIS and PSI receiver operating characteristic curves showed that the BIS monitor was a better predictor of oversedation compared with the PSI (P = .02). Conclusions: There is significant positive correlation between the BIS and PSI but poor correlation and poor test agreement between the RSS and BIS as well as RSS and PSI. The BIS is a better predictor of oversedation compared with the PSI. There was no significant difference between the BIS and PSI with respect to the prediction of undersedation.
KW - Bispectral index
KW - Critically ill
KW - Patient state index
KW - Ramsay sedation scale
KW - Sedation
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U2 - 10.1016/j.jcrc.2008.11.004
DO - 10.1016/j.jcrc.2008.11.004
M3 - Article
C2 - 19540087
AN - SCOPUS:67949121849
SN - 0883-9441
VL - 24
SP - 322
EP - 328
JO - Journal of Critical Care
JF - Journal of Critical Care
IS - 3
ER -