TOP 71 - Correlation of Spectral Electroencephalographic Characteristics with State Behavioral Scale Scores to Assess Sedation Depth in the Pediatric Intensive Care Unit

Publication Number: 1830.TOP 71

Katherine Melink, Boston Children's Hospital, Boston, MA, United States; Aaron C. Spicer, Boston Children's Hospital, Boston, MA, United States; Matthew Luchette, Stanford University, San Francisco, CA, United States; Rocco Landi, Boston Children's Hospital, Boston, MA, United States; Youyang Yang, Boston Children's Hospital, Boston, MA, United States; Kerri LaRovere, Boston Children's Hospital, Boston, MA, United States; Alireza Akhondi-Asl, Boston Children's Hospital, Boston, MA, United States; Samuel L. Hickey, Boston Children's Hospital, Boston, MA, United States; Erik J. Malm, Boston Children's Hospital, Brighton, MA, United States

Background: Depth of sedation can be challenging to accurately assess in intubated children admitted to the pediatric intensive care unit (PICU) due to diverse developmental capabilities, critical illness, and the use of paralysis. Yet, sedation depth has important clinical implications for patient outcomes. The State Behavioral Scale (SBS) was developed to standardize sedation assessments among providers but is user-dependent and only captures data at a select point in time. Electroencephalography (EEG)-based sedation monitors, such as The SedLine device, are used in operating rooms and adult intensive care units to continuously monitor sedation with spectral markers, however these markers have not yet been validated in the PICU population.

Objective: We aimed to (1) describe the pattern of EEG spectrograms in mechanically ventilated PICU patients receiving continuous sedative infusions (2) compare blinded, nurse-assigned SBS scores to the spectral edge frequencies (SEF) and Patient State Index (PSI) values obtained during SedLine recordings and (3) assess how changes to sedative medication dosing affected the correlation between SBS and EEG spectra.

Design/Methods: A single-center prospective observational study of children ages 12 months –21 years admitted to the PICU who are mechanically ventilated via endotracheal tube and receiving a continuous sedative infusion. SedLine EEG was applied to enrolled patients and EEG spectra captured for up to 24 consecutive hours per recording while SBS scores were assigned by nurses using a standardized patient clinical assessment. Dosages of sedative infusions and bolus medications were recorded throughout the study to capture varying depths of sedation. We will compare SBS with SEF and PSI via linear mixed-effects model, with age, illness severity, sedative medication class, and sedative dose as covariates. This analysis will be complete by January 2026.