Abstract
Multi-modal neuroimaging techniques have the potential to dramatically improve the diagnosis of the level consciousness and prognostication of neurological outcome for patients with severe brain injury in the intensive care unit (ICU). This protocol describes a study that will utilize functional Magnetic Resonance Imaging (fMRI), electroencephalography (EEG), and functional Near Infrared Spectroscopy (fNIRS) to measure and map the brain activity of acute critically ill patients. Our goal is to investigate whether these modalities can provide objective and quantifiable indicators of good neurological outcome and reliably detect conscious awareness. To this end, we will conduct a prospective longitudinal cohort study to validate the prognostic and diagnostic utility of neuroimaging techniques in the ICU. We will recruit 350 individuals from two ICUs over the course of 7 years. Participants will undergo fMRI, EEG, and fNIRS testing several times over the first 10 days of care to assess for residual cognitive function and evidence of covert awareness. Patients who regain behavioral awareness will be asked to complete web-based neurocognitive tests for 1 year, as well as return for follow up neuroimaging to determine which acute imaging features are most predictive of cognitive and functional recovery. Ultimately, multi-modal neuroimaging techniques may improve the clinical assessments of patients' level of consciousness, aid in the prediction of outcome, and facilitate efforts to find interventional methods that improve recovery and quality of life.
Highlights
Severe acute brain injury is a medical emergency that requires immediate admission to an intensive care unit (ICU) for lifesustaining therapies
We hypothesize that higher-order auditory and somatosensory processing will be related to better functional outcomes (GOS-E >4 at 12 months post injury), while the absence of low-level sensory processing will be indicative of a poor prognosis
We have previously demonstrated that functional Near Infrared Spectroscopy (fNIRS) can be used to communicate in the ICU with a behaviorally unresponsive patient, allowing him to convey information by imagining playing tennis for “yes” and relaxing for “no”, as see in Figure 5 [24]
Summary
Severe acute brain injury is a medical emergency that requires immediate admission to an intensive care unit (ICU) for lifesustaining therapies. Classifying the level of consciousness at the bedside is imperative, as a growing body of research suggests that these patients may have a period of dissociation between regaining awareness and behavioral responsiveness [8, 9]. To this end, there is a need to develop methods that can be deployed in the ICU to accurately assess residual cognitive function in the early days of injury, thereby improving patient care and inform clinical decision making
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