{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T11:16:55Z","timestamp":1784027815705,"version":"3.55.0"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2007,9,27]],"date-time":"2007-09-27T00:00:00Z","timestamp":1190851200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"},{"start":{"date-parts":[[2007,9,27]],"date-time":"2007-09-27T00:00:00Z","timestamp":1190851200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/2.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                        <jats:title>Introduction<\/jats:title>\n                        <jats:p>Traumatic brain injury and generalized convulsive status epilepticus (GCSE) are conditions that require aggressive management. Barbiturates are used to lower intracranial pressure or to stop epileptiform activity, with the aim being to improve neurological outcome. Dosing of barbiturates is usually guided by the extent of induced burst-suppression pattern on the electroencephalogram (EEG). Dosing beyond the point of burst suppression may increase the risk for complications without offering further therapeutic benefit. For this reason, careful monitoring of EEG parameters is mandatory. A prospective study was conducted to evaluate the usefulness of the bispectral index suppression ratio for monitoring barbiturate coma.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Methods<\/jats:title>\n                        <jats:p>A prospective observational pilot study was performed at a paediatric (surgical) intensive care unit, including all children with barbiturate-induced coma after traumatic brain injury or GCSE. The BIS\u2122 (Bispectral\u2122 index) monitor expresses a suppression ratio, which represents the percentage of epochs per minute in which the EEG was suppressed. Suppression ratios from the BIS monitor were compared with suppression ratios of full-channel EEG as assessed by quantitative visual analysis.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Results<\/jats:title>\n                        <jats:p>Five patients with GCSE and three patients after traumatic brain injury (median age 11.6 years, range 4 months to 15 years) were included. In four patients the correlation between the suppression ratios of the BIS and EEG could be determined; the average correlation was 0.68. In two patients, suppression ratios were either high or low, with no intermediate values. This precluded determination of correlation values, as did the isoelectric EEG in a further two patients. In the latter patients, the mean \u00b1 standard error BIS suppression ratio was 95 \u00b1 1.6.<\/jats:p>\n                     <\/jats:sec><jats:sec>\n                        <jats:title>Conclusion<\/jats:title>\n                        <jats:p>Correlations between suppression ratios of the BIS and EEG were found to be only moderate. In particular, asymmetrical EEGs and EEGs with short bursts (less than 1 second) may result in aberrant BIS suppression ratios. The BIS monitor potentially aids monitoring of barbiturate-induced coma because it provides continuous data on EEG suppression between full EEG registrations, but it should be used with caution.<\/jats:p>\n                     <\/jats:sec>","DOI":"10.1186\/cc6138","type":"journal-article","created":{"date-parts":[[2007,9,27]],"date-time":"2007-09-27T18:13:24Z","timestamp":1190916804000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Continuous noninvasive monitoring of barbiturate coma in critically ill children using the Bispectral\u2122 index monitor"],"prefix":"10.1186","volume":"11","author":[{"given":"Sandra A","family":"Prins","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthijs","family":"de Hoog","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joleen H","family":"Blok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dick","family":"Tibboel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerhard H","family":"Visser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2007,9,27]]},"reference":[{"key":"5572_CR1","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1111\/j.0013-9580.2004.12704.x","volume":"45","author":"P Kwan","year":"2004","unstructured":"Kwan P, Brodie MJ: Phenobarbital for the treatment of epilepsy in the 21st century: a critical review.\n                           Epilepsia 2004, 45: 1141-1149. 10.1111\/j.0013-9580.2004.12704.x","journal-title":"Epilepsia"},{"key":"5572_CR2","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1016\/j.jcrc.2004.07.008","volume":"19","author":"O Yanay","year":"2004","unstructured":"Yanay O, Brogan TV, Martin LD: Continuous pentobarbital infusion in children is associated with high rates of complications.\n                           J Crit Care 2004, 19: 174-178. 10.1016\/j.jcrc.2004.07.008","journal-title":"J Crit Care"},{"key":"5572_CR3","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1016\/S0300-9572(00)00321-X","volume":"48","author":"SR Finfer","year":"2001","unstructured":"Finfer SR, Cohen J: Severe traumatic brain injury.\n                           Resuscitation 2001, 48: 77-90. 10.1016\/S0300-9572(00)00321-X","journal-title":"Resuscitation"},{"key":"5572_CR4","first-page":"S49","volume":"Suppl 3","author":"PD Adelson","year":"2003","unstructured":"Adelson PD, Bratton SL, Carney NA, Chesnut RM, du Coudray HE, Goldstein B, Kochanek PM, Miller HC, Partington MD, Selden NR, et al.: Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. 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The use of barbiturates in the control of intracranial hypertension in severe pediatric traumatic brain injury.\n                           Pediatr Crit Care Med 2003,Suppl 3():S49-S52.","journal-title":"Pediatr Crit Care Med"},{"key":"5572_CR5","doi-asserted-by":"publisher","first-page":"739","DOI":"10.1227\/00006123-199111000-00016","volume":"29","author":"JW Winer","year":"1991","unstructured":"Winer JW, Rosenwasser RH, Jimenez F: Electroencephalographic activity and serum and cerebrospinal fluid pentobarbital levels in determining the therapeutic end point during barbiturate coma.\n                           Neurosurgery 1991, 29: 739-741. discussion 741\u2013732 10.1097\/00006123-199111000-00016","journal-title":"Neurosurgery"},{"key":"5572_CR6","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1038\/385820a0","volume":"385","author":"PA Davies","year":"1997","unstructured":"Davies PA, Hanna MC, Hales TG, Kirkness EF: Insensitivity to anaesthetic agents conferred by a class of GABA\n                           \n                              A\n                           \n                           receptor subunit.\n                           Nature 1997, 385: 820-823. 10.1038\/385820a0","journal-title":"Nature"},{"key":"5572_CR7","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1007\/BF01706327","volume":"16","author":"RC Tasker","year":"1990","unstructured":"Tasker RC, Boyd SG, Harden A, Matthew DJ: The cerebral function analysing monitor in paediatric medical intensive care: applications and limitations.\n                           Intensive Care Med 1990, 16: 60-68. 10.1007\/BF01706327","journal-title":"Intensive Care Med"},{"key":"5572_CR8","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1177\/0885066603262066","volume":"19","author":"RJ Grindstaff","year":"2004","unstructured":"Grindstaff RJ, Tobias JD: Applications of bispectral index monitoring in the pediatric intensive care unit.\n                           J Intensive Care Med 2004, 19: 111-116. 10.1177\/0885066603262066","journal-title":"J Intensive Care Med"},{"key":"5572_CR9","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1097\/00044067-200305000-00009","volume":"14","author":"R Arbour","year":"2003","unstructured":"Arbour R: Continuous nervous system monitoring, EEG, the bispectral index, and neuromuscular transmission.\n                           AACN Clin Issues 2003, 14: 185-207.","journal-title":"AACN Clin Issues"},{"key":"5572_CR10","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1212\/01.wnl.0000173066.89001.f9","volume":"65","author":"JPJ Van Gestel","year":"2005","unstructured":"Van Gestel JPJ, Blusse van Oud-Alblas HJ, Malingre M, Ververs FFT, Braun KPJ, van Nieuwenhuizen O: Propofol and thiopental for refractory status epilepticus in children.\n                           Neurology 2005, 65: 591-592. 10.1212\/01.wnl.0000173066.89001.f9","journal-title":"Neurology"},{"key":"5572_CR11","doi-asserted-by":"publisher","first-page":"S393","DOI":"10.1097\/00003246-200211001-00003","volume":"Suppl 11","author":"CA Mazzola","year":"2002","unstructured":"Mazzola CA, Adelson PD: Critical care management of head trauma in children.\n                           Crit Care Med 2002,Suppl 11():S393-S401. 10.1097\/00003246-200211001-00003","journal-title":"Crit Care Med"},{"key":"5572_CR12","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/S0140-6736(86)90837-8","volume":"1","author":"JM Bland","year":"1986","unstructured":"Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement.\n                           Lancet 1986, 1: 307-310.","journal-title":"Lancet"},{"key":"5572_CR13","volume-title":"Applied Statistics for the Behavioral Sciences","author":"DE Hinkle","year":"1998","unstructured":"Hinkle DE, Wiersma W, Jurs SG: Applied Statistics for the Behavioral Sciences. 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