Mismatch negativity to predict subsequent awakening in deeply sedated critically ill patients

Azabou, Éric; Rohaut, Benjamin; Porcher, Raphaël; Heming, Nicholas; Kandelman, Stanislas; Allary, Jérémy; Moneger, Guy; Faugeras, Frédéric; Sitt, Jacobo; Annane, Djillali; Lofaso, Frédéric; Chrétien, Fabrice; Mantz, Jean; Naccache, Lionel; Sharshar, Tarek

doi:10.1016/j.bja.2018.06.029

Cited by 19 publications

(18 citation statements)

References 66 publications

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“…MMN is a well-established predictor of awakening in non-sedated comatose patients [42], and its prognostic value in deeply sedated critically ill patients also has recently been investigated. MMN can be observed in deeply sedated critically ill patients and can help predict subsequent awakening [43]. There has been only 1 study examining the effects of alterations in brain arousal on EPs, but it focused on the ERP alterations before sleep onset [44].…”

Section: Discussionmentioning

confidence: 99%

Changes in Event-Related Potentials Underlying Coma Recovery in Patients with Large Left Hemispheric Infarction

Jia

Liu

et al. 2019

Med Sci Monit

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Background The aim of this study was to investigate changes in event-related potentials (ERPs) between coma and awakening in patients with large left hemispheric infarction (left LHI). Material/Methods Ten patients with left LHI who suffered coma and survived to awaken were enrolled in this study. The eye-opening subscore of the Glasgow Coma Scale (GCS) was used to assess the extent of patients’ arousal. ERPs elicited by the passive oddball paradigm were collected during coma and awakening states, respectively. Peak latencies, peak amplitudes, topography, and time-frequency information of P1, N1, P2, and mismatch negativity (MMN) were compared between the 2 sessions. Results No significant differences in the peak amplitudes and peak latencies of P1 and N1, but significantly greater P2 amplitude with shorter latency in left hemisphere and midline was shown in the awakening state compared with that in coma. A marked shift of P2 topography in response to deviant tones was also seen, from the right centro-parieto-frontal areas during coma to left frontal-midline areas during awakening. MMN waveforms were not detected in 6/10 patients during the coma state, but these 6 patients all recovered to awakening. Evoked oscillations in bilateral hemisphere were profoundly inhibited during the coma state, with poor inter-trial phase synchronization, while obvious activities with broader frequency ranges and consistent inter-trial phase synchronization were observed during awakening state, and different frequency activities were distributed in distinct brain regions. Conclusions P2 may be a central index of coma recovery and a component of the arousal system. Changes in time-frequency information could provide more information during coma recovery, perhaps including some cognitive processing of the sensory stimulus.

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Section: Discussionmentioning

confidence: 99%

Changes in Event-Related Potentials Underlying Coma Recovery in Patients with Large Left Hemispheric Infarction

Jia

Liu

et al. 2019

Med Sci Monit

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“…S4), with a much less predictive value and we decided not to use them. Recently, MMN was observed in sedated critically ill patients and participate in predicting awakening, but is again not robust enough to be reliable [16]. However, combining multiple sound repetition detections, neuro-imaging methods could be used to probe converging cognitive functions for coma patient [17].…”

Section: Integrative Value Of the New Featuresmentioning

confidence: 99%

Predictive analysis of patient recovery from cardiac-respiratory arrest

Floyrac¹,

Doumergue²,

Kubis

et al. 2019

Preprint

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The severity of neuronal damages in comatose patients following anoxic brain injury can be probed by evoked auditory responses. However, it remains challenging to predict the return to full consciousness of post-anoxic coma of hospitalized patients. We presented here a method to predict the return to consciousness based on the analysis of periodic responses to auditory stimulations, recorded from surface cranial electrodes. The input data are event-related potentials (ERPs), recorded non-invasively with electro-encephalography (EEG). We extracted several novel features from the time series responses in a window of few hundreds of milliseconds from deviant and non-deviant auditory stimulations. We use these features to construct two-dimensional statistical maps, that show two separated clusters for recovered (conscience) and deceased patients, leading to a high classification success as tested by a cross-validation procedure. Finally, using Gaussian, K-neighborhood and SVM classifiers, we construct probabilistic maps to predict the outcome of post-anoxic coma. To conclude, statistics of deviant and non-deviant responses considered separately provide complementary and confirmatory predictions for the outcome of anoxic coma.

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“…This is a highly complex situation compounded by the existence of both primary and secondary brain insults. Clinical relevance of neurological examination-especially brainstem reflex assessment-has previously been demonstrated in non-brain-injured, critically-ill patients (Foo, Loan & Brennan, 2019), including deeply sedated patients (Sharshar et al, 2011a;Rohaut et al, 2017;Azabou et al, 2017Azabou et al, , 2018. Assessment of brainstem reflexes is feasible and reproducible, and constitutes an early independent predictor of ICU-mortality, after adjustment to critical illness severity, sedation level, and sedative doses in non-brain-injured, critically ill patients (Sharshar et al, 2011a;Rohaut et al, 2017;Azabou et al, 2017Azabou et al, , 2018.…”

Section: Introductionmentioning

confidence: 98%

“…Clinical relevance of neurological examination-especially brainstem reflex assessment-has previously been demonstrated in non-brain-injured, critically-ill patients (Foo, Loan & Brennan, 2019), including deeply sedated patients (Sharshar et al, 2011a;Rohaut et al, 2017;Azabou et al, 2017Azabou et al, , 2018. Assessment of brainstem reflexes is feasible and reproducible, and constitutes an early independent predictor of ICU-mortality, after adjustment to critical illness severity, sedation level, and sedative doses in non-brain-injured, critically ill patients (Sharshar et al, 2011a;Rohaut et al, 2017;Azabou et al, 2017Azabou et al, , 2018. Our pathophysiological hypothesis is that critical illness may be associated with brainstem dysfunction, which might itself be caused by the combined effects of critical illness and sedation, and may contribute to mortality, notably via a central autonomic dysfunction (Sharshar et al, 2011a;Rohaut et al, 2017;Benghanem et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients

Kandelman

Allary

Porcher

et al. 2020

PeerJ

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Background Deep sedation may hamper the detection of neurological deterioration in brain-injured patients. Impaired brainstem reflexes within the first 24 h of deep sedation are associated with increased mortality in non-brain-injured patients. Our objective was to confirm this association in brain-injured patients. Methods This was an observational prospective multicenter cohort study involving four neuro-intensive care units. We included acute brain-injured patients requiring deep sedation, defined by a Richmond Assessment Sedation Scale (RASS) < −3. Neurological assessment was performed at day 1 and included pupillary diameter, pupillary light, corneal and cough reflexes, and grimace and motor response to noxious stimuli. Pre-sedation Glasgow Coma Scale (GCS) and Simplified Acute Physiology Score (SAPS-II) were collected, as well as the cause of death in the Intensive Care Unit (ICU). Results A total of 137 brain-injured patients were recruited, including 70 (51%) traumatic brain-injured patients, 40 (29%) vascular (subarachnoid hemorrhage or intracerebral hemorrhage). Thirty patients (22%) died in the ICU. At day 1, the corneal (OR 2.69, p = 0.034) and cough reflexes (OR 5.12, p = 0.0003) were more frequently abolished in patients that died in the ICU. In a multivariate analysis, abolished cough reflex was associated with ICU mortality after adjustment to pre-sedation GCS, SAPS-II, RASS (OR: 5.19, 95% CI [1.92–14.1], p = 0.001) or dose of sedatives (OR: 8.89, 95% CI [2.64–30.0], p = 0.0004). Conclusion Early (day 1) cough reflex abolition is an independent predictor of mortality in deeply sedated brain-injured patients. Abolished cough reflex likely reflects a brainstem dysfunction that might result from the combination of primary and secondary neuro-inflammatory cerebral insults revealed and/or worsened by sedation.

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Mismatch negativity to predict subsequent awakening in deeply sedated critically ill patients

Cited by 19 publications

References 66 publications

Changes in Event-Related Potentials Underlying Coma Recovery in Patients with Large Left Hemispheric Infarction

Changes in Event-Related Potentials Underlying Coma Recovery in Patients with Large Left Hemispheric Infarction

Predictive analysis of patient recovery from cardiac-respiratory arrest

Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients

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