A comparison of gradual sedation levels using the Comfort-B scale and bispectral index in children on mechanical ventilation in the pediatric intensive care unit.

Silva, Cláudia da Costa; Alves, Marta Maria Osório; El Halal, Michel Georges dos Santos; Pinheiro, Sabrina dos Santos; Carvalho, Paulo Roberto Antonacci

OBJECTIVE Compare the scores resulting from the Comfort-B scale with the bispectral index in children in an intensive care unit. METHODS Eleven children between the ages of 1 month and 16 years requiring mechanical ventilation and sedation were simultaneously classified based on the bispectral index and the Comfort-B scale. Their behavior was recorded using digital photography, and the record was later evaluated by three independent evaluators. Agreement tests (Bland-Altman and Kappa) were then performed. The correlation between the two methods (Pearson correlation) was tested. RESULTS In total, 35 observations were performed on 11 patients. Based on the Kappa coefficient, the agreement among evaluators ranged from 0.56 to 0.75 (p<0.001). There was a positive and consistent association between the bispectral index and the Comfort-B scale [r=0.424 (p=0.011) to r=0.498 (p=0.002)]. CONCLUSION Due to the strong correlation between the independent evaluators and the consistent correlation between the two methods, the results suggest that the Comfort-B scale is reproducible and useful in classifying the level of sedation in children requiring mechanical ventilation.