Back to Journals » International Journal of Chronic Obstructive Pulmonary Disease » Volume 13

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

Authors Chalela R, Gallart L, Pascual-Guardia S, Sancho-Muñoz A, Gea J, Orozco-Levi M

Received 1 March 2018

Accepted for publication 15 June 2018

Published 26 September 2018 Volume 2018:13 Pages 2961—2967

DOI https://doi.org/10.2147/COPD.S167020

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell


Video abstract presented by Roberto Chalela.

Views: 567

Roberto Chalela,1–3 Lluis Gallart,4,5 Sergi Pascual-Guardia,1–3 Antonio Sancho-Muñoz,1,2 Joaquim Gea,1–3 Mauricio Orozco-Levi1–3

1Respiratory Medicine Department, Hospital del Mar-IMIM, Barcelona, Spain; 2Department CEXS, Universitat Pompeu Fabra, Barcelona, Spain; 3CIBERES, ISCIII, Barcelona, Spain; 4Department of Anesthesia, Hospital del Mar-IMIM, Barcelona, Spain; 5Universitat Autònoma de Barcelona, Barcelona, Spain

Background: 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.
Objective: The objective of the study was to evaluate the utility of BIS in the assessment of the intensity of hypercapnic encephalopathy in ECOPD patients.
Patients and methods: 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.
Results: 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 (r=-0.757, r=0.701, and r=0.615, respectively; P<0.001 for all). In the stable phase after discharge, BIS showed values considered as normal for a wake state (94.6; 95% CI: 91.7–97.9).
Conclusion: BIS may be useful for the objective early detection and automatic monitoring of the intensity of hypercapnic encephalopathy in ECOPD, facilitating the early detection and follow-up of this condition, which may avoid management problems in these patients.

Keywords: bispectral index, hypercapnic encephalopathy, exacerbation, COPD

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]