Objectives:
To examine neurophysiologic predictors and outcomes of patients with late awakening following cardiac arrest.
Design:
Observational cohort study.
Setting:
Academic ICU.
Patients:
Adult comatose cardiac arrest patients treated with targeted temperature management and sedation.
Interventions:
None.
Measurement and Main Results:
Time to awakening was calculated starting from initial sedation stop following targeted temperature management and rewarming (median 34 hr from ICU admission). Two-hundred twenty-eight of 402 patients (57%) awoke: late awakening (> 48 hr from sedation stop; median time to awakening 5 days [range, 3–23 d]) was observed in 78 subjects (34%). When considering single neurophysiologic tests, late awakening was associated with a higher proportion of discontinuous electroencephalography (21% vs 6% of early awakeners), absent motor and brainstem responses (38% vs 11%; 23 vs 4%, respectively), and serum neuron specific enolase greater than 33 ng/mL (23% vs 8%; all p < 0.01): no patient had greater than 2 unfavorable tests. By multivariable analysis—adjusting for cardiac arrest duration, Sequential Organ Failure Assessment score, and type of sedation—discontinuous electroencephalography and absent neurologic responses were independently associated with late awakening. Late awakening was more frequent with midazolam (58% vs 45%) and was associated with higher rates of delirium (62% vs 39%) and unfavorable 3-months outcome (27% vs 12%; all p = 0.005).
Conclusions:
Late awakening is frequent after cardiac arrest, despite early unfavorable neurophysiologic signs and is associated with greater neurologic complications. Limiting benzodiazepines during targeted temperature management may accelerate awakening. Postcardiac arrest patients with late awakening had a high rate of favorable outcome, thereby supporting prognostication strategies relying on multiple rather than single tests and that allow sufficient time for outcome prediction.
The convection of a magnetically confined plasma resulting from heat and particle sources is studied. It is assumed that the convection is low-level in that the system stays stable to ideal interchange instabilities. A Z-pinch plasma with asymmetric particle and heat sources is considered. It is found that there is no convection if there are no particle sources, independent of the distribution of the heat sources. Particle sources result in convection which in turn influences heat transport. The central temperature, however, may go up or down in response to this convection, depending on the distribution of the source function.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.