Abstract
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 (P = 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.
Highlights
Biomarkers of recovery are greatly needed in coma following traumatic brain injury (TBI) for prognosis and to inform crucial medical and management decisions, including withdrawal of life-sustaining care [1]
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 moderateto-severe TBI, we measured the EEG burst suppression ratio (BSR) during periods of low responsiveness as assessed with the Glasgow Coma Scale (GCS)
Summary
Biomarkers of recovery are greatly needed in coma following traumatic brain injury (TBI) for prognosis and to inform crucial medical and management decisions, including withdrawal of life-sustaining care [1]. Associating electroencephalogram (EEG) patterns such as burst-suppression with patient outcomes may allow for the discovery of prognostic biomarkers. EEG burst-suppression patterns are commonly observed in coma patients, but are challenging to interpret since, in different contexts, their presence may be considered benign, therapeutic, or life-threatening [2]. Pharmacologically-induced burstsuppression (i.e., deep anesthesia) is generally regarded as safe and is often induced intentionally in the intensive care unit (ICU) to reduce the cerebral metabolic rate and intracranial pressure (ICP) in patients with severe traumatic brain injury (TBI) [3, 4] and/or nonconvulsive status epilepticus [5]. To date, no study has investigated the association between this EEG pattern and chronic outcome in patients surviving moderate-to-severe
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