BIS monitoring may help detect delayed cerebral ischemia after aneurysmal SAH.
•A BIS value lesser than 85 in the right and/or left side was the best predictor.
•BIS might be more accurate in the detection of clinical DCI than TCD.
•Asymmetry index failed to detect delayed cerebral ischemia.
AbstractPurposeEvaluate the bispectral index (BIS) monitoring to detect delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH).
Materials and methodsA single-center prospective study in patients with aSAH. BIS monitoring was recorded during 25–120 min in two periods, within the initial 72 h (BIS1) and between days 4 and 6 (BIS2) from admission. The median for each exported BIS parameter was analyzed. Transcranial Doppler (TCD) sonography was simultaneously performed with BIS1 (TCD1) and BIS2 (TCD2) monitoring. A multivariate logistic regression model was built to identify the variables associated with DCI.
ResultsSixty-four patients were included and 16 (25%) developed DCI. During BIS2 monitoring, significant differences were found in BIS value (left, p = 0.01; right, p = 0.009), 95% spectral edge frequency (left and right, p = 0.04), and total power (left and right, p = 0.04). In multivariable analysis, vasospasm on TCD2 (OR 42.8 [95% CI 3.1–573]; p = 0.005), a median BIS2 value <85 in one or both sides (OR 6.2 [95% CI 1.28–30]; p = 0.023), and age (OR 1.08 [95% CI 1.00–1.17]; p = 0.04) were associated with the development of DCI.
ConclusionsBIS value is the most useful BIS parameter for detecting DCI after aSAH. Pending further validation, BIS monitoring might be even more accurate than TCD.
KeywordsSubarachnoid hemorrhage
Intracranial aneurysm
Consciousness monitors
Bispectral index
Vasospasm
Delayed cerebral ischemia
AbbreviationsaSAHaneurysmal subarachnoid hemorrhage
BISvbispectral index value
cEEGcontinuous electroencephalography
DCIdelayed cerebral ischemia
EMGelectromyography activity
NICUneurological intensive care unit
qEEGquantitative electroencephalography
SAHsubarachnoid hemorrhage
SEF9595% spectral edge frequency
SQIsignal quality indicator
WFNSWorld Federation of Neurological Surgeons score
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