Table 3.

Assessment of sedation: outcome of Delphi process for use of pEEG monitors statements

Statement	DI	Median AS	Stopping rulea	Conclusion
1. The level of sedation should be regularly assessed and documented using a validated sedation scoring system	0.007	9	Rd 2	Highly appropriate/strong consensus
2. The desired level of sedation should be identified for each patient and regularly reassessed	0	9	Rd 2	Highly appropriate/strong consensus
3. Doses of sedative agents should be titrated to produce the desired level of sedation	0	9	Rd 2	Highly appropriate/strong consensus
4. pEEG scores vary between patients at the same subjective level of sedation	0.132	8	Rd 2	Highly appropriate/strong consensus
5. Subjective sedation scoring systems are more reproducible than pEEG during light sedation, in which electrical interference due to muscle activity may artificially elevate pEEG values	0.519	7	Rd 2	Appropriate/weak consensus
6. The RASS and SAS are the most valid and reliable sedation assessment tools for measuring quality and depth of sedation in adult ICU patients	0.164	8	Rd 2	Highly appropriate/strong consensus
7. Measures of brain function (BIS, EEG, PSI, or SE) should be used as the primary method to monitor depth of sedation in noncomatose, nonparalyzed critically ill adult patients	0.639	6	Rd 2	Uncertain appropriateness
8. Measures of brain function (BIS, EEG, PSI, or SE) are adequate substitutes for subjective sedation scoring systems	1.53	6	Rd 3	No consensus
9. Measures of brain function (BIS, EEG, PSI, or SE) should be used as the main form of sedation assessment in adult ICU patients who are receiving neuromuscular blocking agents because subjective sedation assessments are unobtainable in these patients	0.132	9	Rd 2	Highly appropriate/strong consensus

List of all voted statements with level of agreement and level of consensus

AS, Appropriateness Score; BIS, Bispectral Index; DI, Disagreement Index; EEG, electroencephalography; pEEG, processed electroencephalography; PSI, Patient State Index; RASS, Richmond Agitation Sedation Score; SAS, Sedation Agitation Score; SE, state entropy

Determined from freehand comments in Rd 1

Although a stopping rule was not reached, these statements were discontinued after Rd 1 because mutually exclusive alternative statements achieved higher appropriateness scores

^aRound (Rd) of the Delphi process after which a stopping rule was reached