Use of BRASS in sedated critically-ill patients as a predictable mortality factor: BRASS-ICU

Abstract

ABSTRACT Objectives: To demonstrate that a BRASS score≥ 3 at admission of intubated, ventilated and sedated patients is predictive of mortality Methods: we have realized an Observational prospective multicenter study. All Major patients without neurological history, admitted to ICU for a non-neurological cause, sedated and admitted under mechanical ventilation were included. Results: One hundred and ten patients were included, the BRASS score as well as the FOUR and RASS scores were collected. At day 28, patients with a BRASS score ≥ 3 had an excess mortality (OR 3.29 – CI 95% [1.42–7.63], p = 0.005) as well as day 90 (OR 2.65 – CI 95% [1.19–5.88], p = 0.02), without impact on the delirium measured by CAM-ICU (OR 1.8 – CI 95% [0.68–4.77], p = 0.023). After adjustment with SAPS II, FOUR and RASS, difference in mortality was not any more different. It is also noted that patients with BRASS ≥ 3 are more sedated (RASS: −5 [−5 – −5] vs −4 [−5 – −3], p < 0.0001) and more comatose (FOUR: 2 [1–4] vs 6 [4–9], p < 0.0001), and have higher doses of midazolam (10 mg/h [5–15] vs 7.5 mg/h [5–10], p = 0.02) and sufentanil (20 μg/h [15–22.5] vs 10 [10–12.5], p = 0.01). Conclusions: The early alteration of brainstem reflexes measured by the BRASS score was not independently predictable in terms of mortality in the non-neurological ICU patients, admitted under sedation and mechanical ventilation. Trial registration: ClinicalTrials.gov Identifier: NCT03835091,Registered 8 February 2019 – prospectively registered, https://clinicaltrials.gov/ct2/show/NCT03835091