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Entropy is more resistant to artifacts than bispectral index in brain-dead organ donors
Authors:Johanna Wennervirta  Tapani Salmi  Markku Hynynen  Arvi Yli-Hankala  Anna-Maria Koivusalo  Mark Van Gils  Reino Pöyhiä  Anne Vakkuri
Affiliation:(1) Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, 340, 00029 Helsinki, Finland;(2) Department of Clinical Neurophysiology, Helsinki University Hospital, Helsinki, Finland;(3) Department of Anesthesia and Intensive Care Medicine, Helsinki University Hospital, Jorvi Hospital, Espoo, Finland;(4) Department of Anesthesia, Tampere University Hospital, and Medical School, University of Tampere, Tampere, Finland;(5) Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Surgical Hospital, Helsinki, Finland;(6) VTT Technical Research Centre of Finland, Tampere, Finland
Abstract:Objective To evaluate the usefulness of entropy and the bispectral index (BIS) in brain-dead subjects. Design and setting A prospective, open, nonselective, observational study in the university hospital. Patients and participants 16 brain-dead organ donors. Interventions Time-domain electroencephalography (EEG), spectral entropy of the EEG, and BIS were recorded during solid organ harvest. Measurements and results State entropy differed significantly from 0 (isoelectric EEG) 28%, response entropy 29%, and BIS 68% of the total recorded time. The median values during the operation were state entropy 0.0, response entropy 0.0, and BIS 3.0. In four of 16 organ donors studied the EEG was not isoelectric, and nonreactive rhythmic activity was noted in time-domain EEG. After excluding the results from subjects with persistent residual EEG activity state entropy, response entropy, and BIS values differed from zero 17%, 18%, and 62% of the recorded time, respectively. Median values were 0.0, 0.0, and 2.0 for state entropy, response entropy, and BIS, respectively. The highest index values in entropy and BIS monitoring were recorded without neuromuscular blockade. The main sources of artifacts were electrocauterization, 50-Hz artifact, handling of the donor, ballistocardiography, electromyography, and electrocardiography. Conclusion Both entropy and BIS showed nonzero values due to artifacts after brain death diagnosis. BIS was more liable to artifacts than entropy. Neither of these indices are diagnostic tools, and care should be taken when interpreting EEG and EEG-derived indices in the evaluation of brain death. This article is discussed in the editorial available at:
Keywords:Electroencephalography  Brain death  Entropy  Bispectral Index
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