Duclos Catherine, Maschke Charlotte, Mahdid Yacine, Nadin Danielle, Rokos Alexander, Arbour Caroline, Badawy Mohamed, Létourneau Justin, Owen Adrian M, Plourde Gilles, Blain-Moraes Stefanie
School of Physical and Occupational Therapy.
Montreal General Hospital.
Am J Respir Crit Care Med. 2022 Jan 15;205(2):171-182. doi: 10.1164/rccm.202105-1223OC.
Predicting recovery of consciousness in unresponsive, brain-injured individuals has crucial implications for clinical decision-making. Propofol induces distinctive brain network reconfiguration in the healthy brain as it loses consciousness. In patients with disorders of consciousness, the brain network's reconfiguration to propofol may reveal the patient's underlying capacity for consciousness. To design and test a new metric for the prognostication of consciousness recovery in disorders of consciousness. Using a within-subject design, we conducted an anesthetic protocol with concomitant high-density EEG in 12 patients with a disorder of consciousness after a brain injury. We quantified the reconfiguration of EEG network hubs and directed functional connectivity before, during, and after propofol exposure and obtained an index of propofol-induced network reconfiguration: the adaptive reconfiguration index. We compared the index of patients who recovered consciousness 3 months after EEG (=3) to that of patients who did not recover or remained in a chronic disorder of consciousness (=7) and conducted a logistic regression to assess prognostic accuracy. The adaptive reconfiguration index was significantly higher in patients who later recovered full consciousness ( value=21, =0.008) and able to discriminate with 100% accuracy whether the patient recovered consciousness. The adaptive reconfiguration index of patients who recovered from a disorder of consciousness at 3-month follow-up was linearly separable from that of patients who did not recover or remained in a chronic disorder of consciousness on the single-subject level. EEG and propofol can be administered at the bedside with few contraindications, affording the adaptive reconfiguration index tremendous translational potential as a prognostic measure of consciousness recovery in acute clinical settings.
预测无反应性脑损伤个体的意识恢复情况对临床决策具有至关重要的意义。丙泊酚会使健康大脑在失去意识时发生独特的脑网络重构。在意识障碍患者中，脑网络对丙泊酚的重构可能揭示患者潜在的意识能力。为了设计并测试一种用于预测意识障碍中意识恢复情况的新指标。我们采用受试者自身对照设计，对12例脑损伤后意识障碍患者进行了一项伴随高密度脑电图监测的麻醉方案。我们量化了丙泊酚给药前、给药期间和给药后的脑电图网络枢纽重构及定向功能连接，并获得了丙泊酚诱导的网络重构指数：适应性重构指数。我们比较了脑电图检查后3个月恢复意识的患者（n = 3）与未恢复意识或仍处于慢性意识障碍状态的患者（n = 7）的该指数，并进行了逻辑回归分析以评估预后准确性。意识完全恢复的患者的适应性重构指数显著更高（数值 = 21，P = 0.008），并且能够以100%的准确率区分患者是否恢复意识。在单受试者水平上，3个月随访时从意识障碍中恢复的患者的适应性重构指数与未恢复或仍处于慢性意识障碍状态的患者的指数呈线性可分离。脑电图检查和丙泊酚可以在床边进行，且禁忌证较少，这使得适应性重构指数作为急性临床环境中意识恢复的预后指标具有巨大的转化潜力。
