Frohlich Joel, Johnson Micah A, McArthur David L, Lutkenhoff Evan S, Dell'Italia John, Real Courtney, Shrestha Vikesh, Spivak Norman M, Ruiz Tejeda Jesús E, Vespa Paul M, Monti Martin M
Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.
Department of Neurosurgery, Brain Injury Research Center (BIRC), UCLA Brain Injury Research Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.
Front Neurol. 2021 Dec 22;12:750667. doi: 10.3389/fneur.2021.750667. eCollection 2021.
While electroencephalogram (EEG) burst-suppression is often induced therapeutically using sedatives in the intensive care unit (ICU), there is hitherto no evidence with respect to its association to outcome in moderate-to-severe neurological patients. We examined the relationship between sedation-induced burst-suppression (SIBS) and outcome at hospital discharge and at 6-month follow up in patients surviving moderate-to-severe traumatic brain injury (TBI). For each of 32 patients recovering from coma after moderate-to-severe TBI, we measured the EEG burst suppression ratio (BSR) during periods of low responsiveness as assessed with the Glasgow Coma Scale (GCS). The maximum BSR was then used to predict the Glasgow Outcome Scale extended (GOSe) at discharge and at 6 months post-injury. A multi-model inference approach was used to assess the combination of predictors that best fit the outcome data. We found that BSR was positively associated with outcomes at 6 months ( = 0.022) but did not predict outcomes at discharge. A mediation analysis found no evidence that BSR mediates the effects of barbiturates or propofol on outcomes. Our results provide initial observational evidence that burst suppression may be neuroprotective in acute patients with TBI etiologies. SIBS may thus be useful in the ICU as a prognostic biomarker.
虽然在重症监护病房（ICU）中，脑电图（EEG）爆发抑制常常通过使用镇静剂进行治疗性诱导，但迄今为止，尚无证据表明其与中重度神经系统疾病患者的预后相关。我们研究了中重度创伤性脑损伤（TBI）幸存者中，镇静诱导爆发抑制（SIBS）与出院时及伤后6个月随访时预后之间的关系。对于32例从中重度TBI昏迷中恢复的患者，我们在以格拉斯哥昏迷量表（GCS）评估的低反应期测量了EEG爆发抑制率（BSR）。然后，使用最大BSR预测出院时及伤后6个月的格拉斯哥扩展预后量表（GOSe）。采用多模型推断方法评估最符合预后数据的预测因子组合。我们发现，BSR与6个月时的预后呈正相关（ = 0.022），但不能预测出院时的预后。中介分析未发现证据表明BSR介导巴比妥类药物或丙泊酚对预后的影响。我们的结果提供了初步的观察证据，表明爆发抑制可能对急性TBI病因患者具有神经保护作用。因此，SIBS可能在ICU中作为一种预后生物标志物有用。
