Brainstem responses can predict death and delirium in sedated patients in intensive care unit*

Sharshar, Tarek; Porcher, Raphaël; Siami, Shidasp; Rohaut, Benjamin; Bailly-Salin, Juliette; Hopkinson, Nicholas S; Clair, Bernard; Guidoux, Céline; Iacobone, Emanuele; Sonneville, Romain; Polito, Andréa; Aboab, Jérôme; Gaudry, Stéphane; Morla, O.; Amouyal, G.; Azuar, Julien; Allary, Jérémy; Vieillard‐Baron, Antoine; Wolff, Michel; Cariou, Alain; Annane, Djillali

doi:10.1097/ccm.0b013e31821b843b

Cited by 52 publications

(45 citation statements)

References 30 publications

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“…Coma was defined as GCS <8 in non-sedated patients or after 3 days of discontinuation of sedation in previously sedated patients [15]. Seizures were defined as generalized or focal (face or limb) tonic or clonic movement or recurrent twitching of one limb or eyelid twitching.…”

Section: Methodsmentioning

confidence: 99%

Pattern of Brain Injury in the Acute Setting of Human Septic Shock

et al. 2013

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BackgroundSepsis-associated brain dysfunction has been linked to white matter lesions (leukoencephalopathy) and ischemic stroke. Our objective was to assess the prevalence of brain lesions in septic shock patients requiring magnetic resonance imaging (MRI) for an acute neurologic change.MethodSeventy-one septic shock patients were included in a prospective observational study. Patients underwent daily neurological examination. Brain MRI was obtained in patients who developed focal neurological deficit, seizure, coma, or delirium. Electroencephalogy was performed in case of coma, delirium, or seizure. Leukoencephalopathy was graded and considered present when white matter lesions were either confluent or diffuse. Patient outcome was evaluated at 6 months with the Glasgow Outcome Scale (GOS).ResultsWe included 71 patients with median age of 65 years (56 to 76) and SAPS II at admission of 49 (38 to 60). MRI was indicated on focal neurological sign in 13 (18%), seizure in 7 (10%), coma in 33 (46%), and delirium in 35 (49%). MRI was normal in 37 patients (52%) and showed cerebral infarcts in 21 (29%), leukoencephalopathy in 15 (21%), and mixed lesions in 6 (8%). EEG malignant pattern was more frequent in patients with ischemic stroke or leukoencephalopathy. Ischemic stroke was independently associated with disseminated intravascular coagulation (DIC), focal neurologic signs, increased mortality, and worse GOS at 6 months.ConclusionsBrain MRI in septic shock patients who developed acute brain dysfunction can reveal leukoencephalopathy and ischemic stroke, which is associated with DIC and increased mortality.

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Section: Methodsmentioning

confidence: 99%

Pattern of Brain Injury in the Acute Setting of Human Septic Shock

et al. 2013

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“…Of the set of brainstem reflexes tested upon admission, we found that the abolition of corneal reflexes was most predictive of BD, and that its predictive value did not differ according to whether the ICH was infratentorial. Sharshar et al [43] recently reported the neurological examination of sedated (by midazolam with or without sufentanil) patients admitted to the ICU without neurological disease [43]; corneal reflexes were abolished in <10% of sedated patients, and other brainstem reflexes were abolished in 20-50% of them [43]. Considering that 61% of our patients had received midazolam with or without sufentanil before admission to the ICU, we speculate that the minor effect of these sedatives on the corneal reflexes may explain why the abolition of these reflexes was the variable most predictive of BD.…”

Section: Discussionmentioning

confidence: 99%

Prediction of evolution toward brain death upon admission to ICU in comatose patients with spontaneous intracerebral hemorrhage using simple signs

et al. 2013

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“…The FOUR score adds an additional layer of sophistication to the assessment of coma by scoring brainstem reflexes in addition to the classical eye, motor and verbal responses elicited spontaneously or in response to a nociceptive stimuli. For example, an absent cough reflex is associated with 28‐day mortality in sedated critically ill patients [17]. …”

Section: Syndromesmentioning

confidence: 99%

“…Brainstem dysfunction might result in impaired alertness and impaired cardiovascular and immune controls, thereby leading to increased mortality. We found that the early abolition of the cough reflex and oculocephalogyric response was independently associated with increased ICU mortality in sedated critically ill patients [17]. Decreased heart rate variability, reflecting an impaired sympathetic activity originating from the brainstem autonomic centers, is also associated with a worse outcome in sepsis [30].…”

Section: Structuresmentioning

confidence: 99%

Neuroanatomy of sepsis-associated encephalopathy

et al. 2017

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This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2017. Other selected articles can be found online at http://ccforum.com/series/annualupdate2017. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.Originally published in the Annual Update in Intensive Care and Emergency Medicine 2017. The number of authors differs in the two versions due to constraints regarding the number of authors in the Annual Update in Intensive Care and Emergency Medicine. In the Annual Update version of the review, the three senior authors appear in the acknowledgement section. In the Critical Care version, these three senior authors appear as full authors of the manuscript. All authors helped draft and revise the manuscript for critical intellectual content.

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Brainstem responses can predict death and delirium in sedated patients in intensive care unit*

Abstract: Assessment of brainstem responses is feasible in sedated critically ill patients and loss of selected responses is predictive of mortality and altered mental status.

Cited by 52 publications

References 30 publications

Pattern of Brain Injury in the Acute Setting of Human Septic Shock

Pattern of Brain Injury in the Acute Setting of Human Septic Shock

Prediction of evolution toward brain death upon admission to ICU in comatose patients with spontaneous intracerebral hemorrhage using simple signs

Neuroanatomy of sepsis-associated encephalopathy

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