| Author | Kandelman, Stanislas | |
| Author | Allary, Jérémy | |
| Author | Porcher, Raphael | |
| Author | Righy, Cássia | |
| Author | Valdez, Clarissa Francisca | |
| Author | Rasulo, Frank | |
| Author | Heming, Nicholas | |
| Author | Moneger, Guy | |
| Author | Azabou, Eric | |
| Author | Savary, Guillaume | |
| Author | Annane, Djillali | |
| Author | Chretien, Fabrice | |
| Author | Latronico, Nicola | |
| Author | Bozza, Fernando A. | |
| Author | Rohaut, Benjamin | |
| Author | Sharshar, Tarek | |
| Access date | 2021-01-19T21:00:41Z | |
| Available date | 2021-01-19T21:00:41Z | |
| Document date | 2020 | |
| Citation | KANDELMAN, Stanislas et al. Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients. PeerJ, v. 8, p. 1-16, Nov. 2020. | pt_BR |
| ISSN | 2167-8359 | pt_BR |
| URI | https://www.arca.fiocruz.br/handle/icict/45751 | |
| Language | eng | pt_BR |
| Publisher | PeerJ | pt_BR |
| Rights | open access | pt_BR |
| Title | Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients | pt_BR |
| Type | Article | pt_BR |
| DOI | 10.7717/peerj.10326 | |
| Abstract | Background: Deep sedation may hamper the detection of neurological deterioration in brain-injured patients. Impaired brainstem reflexes within the first 24 h of deep sedation are associated with increased mortality in non-brain-injured patients. Our objective was to confirm this association in brain-injured patients. Methods: This was an observational prospective multicenter cohort study involving four neuro-intensive care units. We included acute brain-injured patients requiring deep sedation, defined by a Richmond Assessment Sedation Scale (RASS) < -3. Neurological assessment was performed at day 1 and included pupillary diameter, pupillary light, corneal and cough reflexes, and grimace and motor response to noxious stimuli. Pre-sedation Glasgow Coma Scale (GCS) and Simplified Acute Physiology Score (SAPS-II) were collected, as well as the cause of death in the Intensive Care Unit (ICU). Results: A total of 137 brain-injured patients were recruited, including 70 (51%) traumatic brain-injured patients, 40 (29%) vascular (subarachnoid hemorrhage or intracerebral hemorrhage). Thirty patients (22%) died in the ICU. At day 1, the corneal (OR 2.69, p = 0.034) and cough reflexes (OR 5.12, p = 0.0003) were more frequently abolished in patients that died in the ICU. In a multivariate analysis, abolished cough reflex was associated with ICU mortality after adjustment to pre-sedation GCS, SAPS-II, RASS (OR: 5.19, 95% CI [1.92-14.1], p = 0.001) or dose of sedatives (OR: 8.89, 95% CI [2.64-30.0], p = 0.0004). Conclusion: Early (day 1) cough reflex abolition is an independent predictor of mortality in deeply sedated brain-injured patients. Abolished cough reflex likely reflects a brainstem dysfunction that might result from the combination of primary and secondary neuro-inflammatory cerebral insults revealed and/or worsened by sedation. | pt_BR |
| Affilliation | University Denis Diderot. Beaujon Hospital. Department of Anesthesiology and Intensive Care Unit. Clichy, France / McGill University Health Center. Royal Victoria Hospital. Department of Anesthesia. Montréal, QC, Canada. | pt_BR |
| Affilliation | University Denis Diderot. Beaujon Hospital. Department of Anesthesiology and Intensive Care Unit. Clichy, France. | pt_BR |
| Affilliation | University Paris Descartes. Hotel Dieu Hospital. Assistance Publique Hôpitaux de Paris. Center for Clinical Epidemiology. Paris, France. | pt_BR |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto Estadual do Cérebro Paulo Niemeyer. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil. | pt_BR |
| Affilliation | Instituto Estadual do Cérebro Paulo Niemeyer. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil / Hospital das Américas. Unidade de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil. | pt_BR |
| Affilliation | Spedali Civili University Hospital. Department of Anesthesia. Critical Care and Emergency. Brescia, Italy / University of Brescia. Radiological Sciences and Public Health. Department of Medical and Surgical Specialties. Brescia, Italy. | pt_BR |
| Affilliation | University of Versailles Saint-Quentin en Yvelines. Raymond-Poincaré Hospital. Assistance Publique Hôpitaux de Paris. General Intensive Care Unit. Garches, France. | pt_BR |
| Affilliation | University of Versailles Saint-Quentin en Yvelines. Raymond-Poincaré Hospital. Assistance Publique Hôpitaux de Paris. General Intensive Care Unit. Garches, France. | pt_BR |
| Affilliation | University of Versailles Saint-Quentin en Yvelines. Raymond-Poincaré Hospital. Assistance Publique Hôpitaux de Paris. Department of Physiology. Garches, France. | pt_BR |
| Affilliation | University Denis Diderot. Beaujon Hospital. Department of Anesthesiology and Intensive Care Unit. Clichy, France. | pt_BR |
| Affilliation | University of Versailles Saint-Quentin en Yvelines. Raymond-Poincaré Hospital. Assistance Publique Hôpitaux de Paris. General Intensive Care Unit. Garches, France. | pt_BR |
| Affilliation | Institut Pasteur. Laboratory of Human Histopathology and Animal Models. Paris, France. | pt_BR |
| Affilliation | Spedali Civili University Hospital. Department of Anesthesia, Critical Care and Emergency. Brescia, Italy / University of Brescia. Radiological Sciences and Public Health. Department of Medical and Surgical Specialties. Brescia, Italy. | pt_BR |
| Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto D'Or de Pesquisa e Educação. Rio de Janeiro, RJ, Brasil. | pt_BR |
| Affilliation | Groupe Hospitalier Pitié-Salpêtrière. Intensive Care Unit. Department of Neurology. Paris, France / Sorbonne Universités. Faculté de Médecine Pitié-Salpêtrière. Paris, France / Columbia University. Critical Care Neurology. Department of Neurology. New York, NY, USA. | pt_BR |
| Affilliation | Institut Pasteur. Laboratory of Human Histopathology and Animal Models. Paris, France / Instituto D'Or de Pesquisa e Educação. Rio de Janeiro, RJ, Brasil / University of Paris-Descartes. Sainte-Anne Teaching Hospital. Neuro-Anesthesiology and Intensive Care Unit. Paris, France. | pt_BR |
| Subject | Brain injury | pt_BR |
| Subject | Brainstem dysfunction | pt_BR |
| Subject | Cough reflex | pt_BR |
| Subject | Critical care | pt_BR |
| Subject | Deep sedation | pt_BR |
| Subject | Neurological examination | pt_BR |
| Subject | Neuroprognosis | pt_BR |
