Service de neurophysiologie et d'épileptologie, hôpital Neurologique P.-Wertheimer, hospices civils de Lyon (HCL), 59, boulevard Pinel, 69677 Bron cedex, France; Inserm U 1028, NeuroPain team, centre de recherche en neuroscience de Lyon (CRNL), université Lyon 1, 69677 Bron cedex, France.
Service de neurophysiologie clinique, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris (AP-HP), 47-83, boulevard de l'hôpital, 75013 Paris, France.
Neurophysiol Clin. 2018 Jun;48(3):143-169. doi: 10.1016/j.neucli.2018.05.038. Epub 2018 May 18.
Predicting the outcome of a comatose or poorly responsive patient is a major issue for intensive care unit teams, in order to give the most accurate information to the family and to choose the best therapeutic option. However, determining the level of cortical activity in patients with disorders of consciousness is a real challenge. Reliable criteria are required to help clinicians in the decision-making process, especially in the acute phase of coma. In this paper, we propose recommendations for recording and interpreting electroencephalography and evoked potentials in comatose patients based on the literature and the clinical experience of a group of neurophysiologists trained in the management of comatose patients. We propose methodological guidelines and discuss prognostic value of each test as well as the limitations concerning recording and interpretation. Recommendations for the strategy and timing of neurophysiological assessments are also proposed according to various clinical situations.
预测昏迷或反应迟钝患者的预后是重症监护病房团队面临的一个主要问题，以便向家属提供最准确的信息，并选择最佳的治疗方案。然而，确定意识障碍患者的皮质活动水平是一个真正的挑战。需要可靠的标准来帮助临床医生做出决策，特别是在昏迷的急性期。在本文中，我们根据文献和一组受过昏迷患者管理培训的神经生理学家的临床经验，就昏迷患者的脑电图和诱发电位记录和解释提出建议。我们提出了方法学指南，并讨论了每项测试的预后价值，以及记录和解释方面的局限性。还根据各种临床情况提出了神经生理评估策略和时间的建议。
