Duclos Catherine, Norton Loretta, Laforge Geoffrey, Frantz Allison, Maschke Charlotte, Badawy Mohamed, Letourneau Justin, Slessarev Marat, Gofton Teneille, Debicki Derek, Owen Adrian M, Blain-Moraes Stefanie
School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada.
Front Hum Neurosci. 2020 Nov 12;14:582125. doi: 10.3389/fnhum.2020.582125. eCollection 2020.
Individuals who have suffered a severe brain injury typically require extensive hospitalization in intensive care units (ICUs), where critical treatment decisions are made to maximize their likelihood of recovering consciousness and cognitive function. These treatment decisions can be difficult when the neurological assessment of the patient is limited by unreliable behavioral responses. Reliable objective and quantifiable markers are lacking and there is both (1) a poor understanding of the mechanisms underlying the brain's ability to reconstitute consciousness and cognition after an injury and (2) the absence of a reliable and clinically feasible method of tracking cognitive recovery in ICU survivors. Our goal is to develop and validate a clinically relevant EEG paradigm that can inform the prognosis of unresponsive, brain-injured patients in the ICU. This protocol describes a study to develop a point-of-care system intended to accurately predict outcomes of unresponsive, brain-injured patients in the ICU. We will recruit 200 continuously-sedated brain-injured patients across five ICUs. Between 24 h and 7 days post-ICU admission, high-density EEG will be recorded from behaviorally unresponsive patients before, during and after a brief cessation of pharmacological sedation. Once patients have reached the waking stage, they will be asked to complete an abridged Cambridge Brain Sciences battery, a web-based series of neurocognitive tests. The test series will be repeated every day during acute admission (ICU, ward), or as often as possible given the constraints of ICU and ward care. Following discharge, patients will continue to complete the same test series on weekly, and then monthly basis, for up to 12 months following injury. Functional outcomes will also be assessed up to 12 months post-injury. We anticipate our findings will lead to an increased ability to identify patients, as soon as possible after their brain injury, who are most likely to survive, and to make accurate predictions about their long-term cognitive and functional outcome. In addition to providing critically needed support for clinical decision-making, this study has the potential to transform our understanding of key functional EEG networks associated with consciousness and cognition.
遭受严重脑损伤的患者通常需要在重症监护病房（ICU）接受长期住院治疗，在那里要做出关键的治疗决策，以最大程度地提高他们恢复意识和认知功能的可能性。当患者的神经学评估受到不可靠行为反应的限制时，这些治疗决策会变得困难。目前缺乏可靠的客观且可量化的指标，并且存在以下两个问题：（1）对脑损伤后大脑恢复意识和认知能力的潜在机制了解不足；（2）缺乏一种可靠且临床上可行的方法来跟踪ICU幸存者的认知恢复情况。我们的目标是开发并验证一种与临床相关的脑电图范式，该范式可为ICU中无反应的脑损伤患者的预后提供信息。本方案描述了一项旨在开发一种即时护理系统的研究，该系统旨在准确预测ICU中无反应的脑损伤患者的预后。我们将在五个ICU中招募200名持续接受镇静的脑损伤患者。在入住ICU后的24小时至7天内，将在行为无反应的患者在短暂停止药物镇静之前、期间和之后记录高密度脑电图。一旦患者进入清醒阶段，将要求他们完成一套简化的剑桥脑科学测试组合，这是一系列基于网络的神经认知测试。在急性住院期间（ICU、病房），每天都会重复进行该测试组合，或者在ICU和病房护理的限制条件下尽可能频繁地进行。出院后，患者将在受伤后的12个月内，每周然后每月继续完成相同的测试组合。还将在受伤后长达12个月的时间内评估功能结局。我们预计我们的研究结果将提高在脑损伤后尽快识别最有可能存活的患者的能力，并对他们的长期认知和功能结局做出准确预测。除了为临床决策提供急需的支持外，这项研究还有可能改变我们对与意识和认知相关的关键功能性脑电图网络的理解。
