The SNAP index does not correlate with the State Behavioral Scale in intubated and sedated children

Abstract

Background Ensuring appropriate levels of sedation for critically ill children is integral to pediatric critical care. Traditionally, clinicians have used subjective scoring tools to assess sedation levels. The SNAP II uses dual frequency processed electroencephalography to evaluate brain activity and may provide an objective assessment of sedation levels. Objective This study attempts to find an objective method to monitor sedation in critically ill pediatric patients. We compared the SNAP II, a processed electroencephalography device, with the State Behavioral Scale (SBS), a subjective sedation scoring tool. We hypothesize that the SNAP II correlates with the SBS and has less observer bias. Methods This was an IRB approved prospective, observational study. Patients receiving intravenous sedation while being mechanically ventilated were enrolled after informed consent. After the SNAP II monitoring electrodes were attached, blinded bedside nurses assessed sedation levels using the SBS. SNAP indices were collected and compared with SBS scores to determine correlation. Results We compared 417 paired data points from 15 patients using Pearson's correlation and Least Squares Means to determine correlation between the SBS and SNAP indices. No correlation was observed. Using covariance model patterning for repeated measures to adjust for covariates again showed no correlation. Conclusion The SNAP index does not correlate with SBS scores in our PICU. Its use cannot be recommended to measure levels of sedation in our population. Future research should continue to explore objective ways of measuring sedation in critically ill children.

2022 Society of Critical Care Medicine Clinical Practice Guidelines on Prevention and Management of Pain, Agitation, Neuromuscular Blockade, and Delirium in Critically Ill Pediatric Patients With Consideration of the ICU Environment and Early Mobility

“…Formal measurement of brain activity has been proposed as an adjunct modality to complement clinical assessment or be used when clinical assessments are not available. Three electroencephalogram-based monitors have been evaluated in critically ill children including the bispectral index (BIS) (186), the SNAP II monitor (187,188), and the amplified electroencephalogram (aEEG), although aEEG has been almost exclusively used to predict outcomes following neonatal hypoxemic ischemic injury (189)(190)(191). BIS monitoring has been the most widely evaluated tool in critically ill children (186).…”

Discomfort of the critically ill paediatric patient and correlated variables

“…8,9 The most commonly used strategy for managing the comfort of critically ill paediatric patients is sedation and analgesia. 3,10,11 The optimal use of analgosedation allows for invasive procedures to be carried out safely by permitting synchronisation and patient tolerance of mechanical ventilation (MV), 11 preventing accidental extubation and reducing both metabolic 12 and oxygen consumption in the case of shock. 13 Pharmacological therapy to control pain, induce comfort, and produce tolerance of an apparently hostile environment in critically ill patients is based on substances such as sedatives/hypnotics and analgesics.…”