首页 文献索引 SCI期刊 AI助手
首页 正文

Intensive care medicine. 2025 Jun 13. doi: 10.1007/s00134-025-07945-7 Q129.62024

Altered lower brainstem neurophysiological response is associated with mortality in deeply sedated critically ill patients

镇静重症患者的脑干神经生理学反应改变与死亡率相关 翻译改进

Eléonore Bouchereau  1  2, Estelle Pruvost-Robieux  3  2, Shidasp Siami  4, Cendrine Chaffaut  5  6, Adrien Bouglé  7, Martine Gavaret  3  2, Nicholas Heming  8, Sivanthiny Sivanandamoorthy  4, Julie Zyss  9, Vincent Degos  10, Stanislas Kandelman  11, Cassia Righy Shinotsuka  12  13, Sarah Benghanem  14, Lionel Naccache  9, Benjamin Rohaut  15, Bertrand Hermann  1  2  16, Eric Azabou  17, Sylvie Chevret  5  6, Tarek Sharshar  18  19

作者单位 +展开

作者单位

  • 1 Anesthesia and Intensive Care Department, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Paris, France.
  • 2 Institute of Psychiatry, Neurosciences of Paris, INSERM U1266, Université Paris Cité, Paris, France.
  • 3 Department of Clinical Neurophysiology, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Paris, France.
  • 4 General Intensive Care Unit, Sud-Essonne Hospital, Etampes, France.
  • 5 Department of Biostatistics, Hôpital Saint-Louis, AP-HP, Paris, France.
  • 6 Université Paris Cité, Inserm UMR 1153, Paris, France.
  • 7 Department of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
  • 8 General Intensive Care Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France.
  • 9 Department of Clinical Neurophysiology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
  • 10 Department of Anesthesiology and Critical Care, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France.
  • 11 Department of Anesthesiology, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada.
  • 12 Department of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil.
  • 13 Laboratório de Medicina Intensiva, Fundação Oswaldo Cruz, Instituto Nacional de Infectologia, Rio de Janeiro, Brazil.
  • 14 Medical Intensive Care Unit, Cochin Hospital, Assistance Publique - Hôpitaux de Paris-Centre (APHP-Centre), Paris, France.
  • 15 Department of Neurology, Neuro-ICU & Brain Institute - ICM, Pitié-Salpêtrière Hospital APHP, Sorbonne Université, Paris, France.
  • 16 Medical Intensive Care Unit, HEGP Hospital, Assistance Publique - Hôpitaux de Paris-Centre (APHP-Centre), Paris, France.
  • 17 Department of Physiology and Department of Critical Care Medicine, Inserm UMR 1173 Infection and Inflammation, Raymond Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), University of Versailles Saint Quentin (UVSQ), University Paris-Saclay, Garches, Paris, France.
  • 18 Anesthesia and Intensive Care Department, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Paris, France. t.sharshar@ghu-paris.fr.
  • 19 Neuro-Anesthesiology and Intensive Care Medicine, GHU-Paris Psychiatrie Et Neurosciences, Université de Paris, Paris, France. t.sharshar@ghu-paris.fr.

    • DOI: 10.1007/s00134-025-07945-7 PMID: 40512201

    摘要 中英对照阅读

    Background and objectives: Absent cough reflex is associated with mortality in intensive care unit (ICU) patients requiring deep sedation, suggesting that lower brainstem dysfunction contributes to adverse outcomes. We conducted a multicenter observational cohort study to confirm this hypothesis by assessing the peak latency (PL) of the lower brainstem-generated P14 evoked potential (EP), which is slightly increased by sedatives. We aimed to demonstrate that a P14-PL > 16 ms is independently associated with day-28 mortality.

    Patients and methods: Mechanically ventilated adult patients, comatose or deeply sedated, brain injured or not, were included. At day 3, EPs were performed in patients remaining unconscious. The Simplified Acute Physiological Score (SAPSII), initial Glasgow Coma Scale (GCS), sedation depth, and brainstem reflexes were collected. The primary outcome was day-28 mortality. The secondary outcomes were delayed awakening and delirium after sedation discontinuation.

    Results: Between 2015 and 2019, 322 patients were included. EPs were performed in 264 (82%) patients, including 140 (53%) brain-injured and 251 (95%) deeply sedated patients. The median age, SAPSII and initial GCS were 62 [50; 71], 49 [40; 62] and 11 years [6; 15], respectively. A P14-PL > 16 ms was found in 76 (29%) patients and was associated with day-28 mortality (adjusted hazard ratio, 3.0; 95% confidence interval, [1.7-5.2]). Absent cough and pupillary light reflexes were associated with death. Only absent oculocephalogyric reflex was associated with delayed awakening (adjusted odds ratio, 2.1, 95%CI, [1.1-3.7]).

    Interpretation: Impaired neurological and neurophysiological lower brainstem responses are associated with mortality in deeply sedated patients. Funded by the French Ministry of Health; PRORETRO; no. P120915; ClinicalTrials.gov registry: NCT02395861; date: 24 March 2015.

    Keywords: Brain-injured patients; Coma; Critical care; Evoked potentials; Neuroprognostication.

    Keywords：lower brainstem; neurophysiological response; mortality; sedated; critically ill patients

    背景和目标： 无咳嗽反射与重症监护病房（ICU）中需要深度镇静患者的死亡率相关，表明脑干下部功能障碍可能导致不良结局。我们进行了一项多中心观察性队列研究，通过评估由脑干下部产生的P14诱发电位（EP）的峰值潜伏期（PL），该指标略受镇静剂影响来验证这一假设。我们的目标是证明P14-PL > 16 ms 独立与28天死亡率相关。

    患者和方法： 研究纳入了机械通气的成年患者，这些患者处于昏迷状态或深度镇静状态，无论是否有脑损伤。在第3天，对仍处于无意识状态的患者进行EP检测。收集Simplified Acute Physiological Score（SAPS II）、初始Glasgow Coma Scale（GCS）评分、镇静程度和脑干反射的数据。主要结局指标是28天死亡率。次要结局指标是在停止镇静后出现延迟觉醒和谵妄。

    结果： 在2015年至2019年间，共有322名患者被纳入研究。其中264（82%）名患者进行了EP检测，包括140（53%）脑损伤和251（95%）深度镇静的患者。中位年龄、SAPS II 和初始GCS分别为 62 [50;71]、49 [40;62] 年和 11 分 [6;15]。在76（29%）名患者中发现P14-PL > 16 ms，与28天死亡率相关（校正危险比为3.0；95％置信区间[1.7-5.2]）。无咳嗽反射和瞳孔光反射与死亡相关。只有缺失的脑干反射（眼心反射）与延迟觉醒相关（校正优势比，2.1, 95%CI [1.1-3.7]）。

    解读： 深度镇静患者的神经生理学和神经系统下脑干反应受损与死亡率相关。该研究由法国卫生部资助；PRORETRO；编号P120915；ClinicalTrials.gov 注册号：NCT02395861；日期：2015年3月24日。

    关键词： 脑损伤患者；昏迷；重症监护；诱发电位；神经预后判断。

    关键词：脑干; 生理学反应; 死亡率; 使用镇静剂; 重症患者

    翻译效果不满意？ 用Ai改进或 寻求AI助手帮助 ，对摘要进行重点提炼
    Copyright © Intensive care medicine. 中文内容为AI机器翻译，仅供参考！

    相关内容

    期刊名：Intensive care medicine

    缩写：INTENS CARE MED

    ISSN：0342-4642

    e-ISSN：1432-1238

    IF/分区：29.6/Q1

    文章目录 更多期刊信息

    全文链接
    官方链接
    PMC全文
    引文链接
    复制
    已复制！
    推荐内容
    Altered lower brainstem neurophysiological response is associated with mortality in deeply sedated critically ill patients