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Br J Anaesth. 2018 Dec;121(6):1290-1297. doi: 10.1016/j.bja.2018.06.029. Epub 2018 Sep 4.

Mismatch negativity to predict subsequent awakening in deeply sedated critically ill patients.

Author information

1
Department of Physiology, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1179, University of Versailles Saint-Quentin en Yvelines, Garches, Paris, France; General Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U1173, University of Versailles Saint-Quentin en Yvelines, Garches, France.
2
Department of Neurology, Neuro-ICU, Columbia University, New York, NY, USA.
3
Center for Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Hotel Dieu Hospital, University Paris Descartes, INSERM U1153, Paris, France.
4
General Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U1173, University of Versailles Saint-Quentin en Yvelines, Garches, France.
5
Department of Anesthesiology and Intensive Care Medicine, Beaujon Hospital, University of Denis Diderot, Clichy, France.
6
Institut du Cerveau et de la Moelle épinière, Paris, France.
7
Department of Physiology, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1179, University of Versailles Saint-Quentin en Yvelines, Garches, Paris, France.
8
Laboratory of Experimental Neuropathology, Institut Pasteur, Paris, France.
9
Laboratory of Experimental Neuropathology, Institut Pasteur, Paris, France; Department of Anesthesiology and Intensive Care Medicine, European Hospital Georges Pompidou, Paris Descartes University, Paris, France.
10
Laboratory of Experimental Neuropathology, Institut Pasteur, Paris, France; Department of Neuro-Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris, France; Laboratoire de Neuropathologie Expérimentale, Institut Pasteur, Paris, France. Electronic address: tarek.sharshar@pasteur.fr.

Abstract

BACKGROUND:

Mismatch negativity (MMN) is the neurophysiological correlate of cognitive integration of novel stimuli. Although MMN is a well-established predictor of awakening in non-sedated comatose patients, its prognostic value in deeply sedated critically ill patients remains unknown. The aim of this prospective, observational pilot study was to investigate the prognostic value of MMN for subsequent awakening in deeply sedated critically ill patients.

METHODS:

MMN was recorded in 43 deeply sedated critically ill patients on Day 3 of ICU admission using a classical 'odd-ball' paradigm that delivers rare deviant sounds in a train of frequent standard sounds. Individual visual analyses and a group level analysis of recordings were performed. MMN amplitudes were then analysed according to the neurological status (awake vs not awake) at Day 28.

RESULTS:

Median (inter-quartile range) Richmond Assessment Sedation Scale (RASS) at the time of recording was -5 (range, from -5 to -4.5). Visual detection of MMN revealed a poor inter-rater agreement [kappa=0.17, 95% confidence interval (0.07-0.26)]. On Day 28, 30 (70%) patients had regained consciousness while 13 (30%) had not. Quantitative group level analysis revealed a significantly greater MMN amplitude for patients who awakened compared with those who had not [mean (standard deviation) = -0.65 (1.4) vs 0.08 (0.17) μV, respectively; P=0.003).

CONCLUSIONS:

MMN can be observed in deeply sedated critically ill patients and could help predict subsequent awakening. However, visual analysis alone is unreliable and should be systematically completed with individual level statistics.

KEYWORDS:

coma; deep sedation; electroencephalography; event-related potentials; intensive care unit; neuroprognosis

PMID:
30442256
DOI:
10.1016/j.bja.2018.06.029
[Indexed for MEDLINE]

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