Bispectral index in hypercapnic encephalopathy associated with COPD exacerbation: a pilot study

• Published in: International journal of chronic obstructive pulmonary disease 2018-01, Vol.13, p.2961-2967
• Main Authors: Chalela, Roberto, Gallart, Lluis, Pascual-Guardia, Sergi, Sancho-Muñoz, Antonio, Gea, Joaquim, Orozco-Levi, Mauricio
• Format: Article
• Language: English
• Subjects: Acidosis; Aged; Analysis; Anesthesia; Bispectral Index; Brain Diseases - diagnostic imaging; Brain Diseases - etiology; Brain Diseases - therapy; Case-Control Studies; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Coma; Conscious Sedation - methods; Consciousness; Consciousness Monitors; COPD; Disease Progression; Early Diagnosis; Electroencephalography; Electroencephalography - methods; Emergency Service, Hospital; Encephalopathy; Exacerbation; Female; Glasgow Coma Scale; Humans; Hypercapnia; Hypercapnic encephalopathy; Intubation; Male; Middle Aged; Monitoring, Physiologic - instrumentation; Monitoring, Physiologic - methods; Original Research; Patients; Pilot Projects; Prognosis; Prospective Studies; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - diagnosis; Risk Assessment; Severity of Illness Index; Treatment Outcome; Variables
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S167020

Hypercapnic encephalopathy is relatively frequent in severe exacerbations of COPD (ECOPDs), with its intensity usually being evaluated through clinical scales. Bispectral index (BIS) is a relatively new technique, based on the analysis of the electroencephalographic signal, which provides a good approximation to the level of consciousness, having already been validated in anesthesia. The objective of the study was to evaluate the utility of BIS in the assessment of the intensity of hypercapnic encephalopathy in ECOPD patients. A total of ten ECOPD patients were included, and the level of brain activity was assessed using BIS and different scales: Glasgow Coma Scale, Ramsay Sedation Scale (RSS), and Richmond Agitation-Sedation Scale. The evaluation was performed both in the acute phase and 3 months after discharge. BIS was recorded for a total of about 600 minutes. During ECOPD, BIS values ranged from 58.8 (95% CI: 48.6-69) for RSS score of 4 to 92.2 (95% CI: 90.1-94.3) for RSS score of 2. A significant correlation was observed between values obtained with BIS and those from the three scales, although the best fit was for RSS, followed by Glasgow and Richmond ( =-0.757, =0.701, and =0.615, respectively;