Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients

Detalhes bibliográficos
Autor(a) principal: Kandelman, Stanislas
Data de Publicação: 2020
Outros Autores: Allary, Jérémy, Porcher, Raphael, Righy, Cássia, Valdez, Clarissa Francisca, Rasulo, Frank, Heming, Nicholas, Moneger, Guy, Azabou, Eric, Savary, Guillaume, Annane, Djillali, Chretien, Fabrice, Latronico, Nicola, Bozza, Fernando Augusto, Rohaut, Benjamin, Sharshar, Tarek
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
Texto Completo: https://www.arca.fiocruz.br/handle/icict/45751
Resumo: 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.
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spelling Kandelman, StanislasAllary, JérémyPorcher, RaphaelRighy, CássiaValdez, Clarissa FranciscaRasulo, FrankHeming, NicholasMoneger, GuyAzabou, EricSavary, GuillaumeAnnane, DjillaliChretien, FabriceLatronico, NicolaBozza, Fernando AugustoRohaut, BenjaminSharshar, Tarek2021-01-19T21:00:41Z2021-01-19T21:00:41Z2020KANDELMAN, Stanislas et al. Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients. PeerJ, v. 8, p. 1-16, 20202167-8359https://www.arca.fiocruz.br/handle/icict/4575110.7717/peerj.10326engPeerJEarly abolition of cough reflex predicts mortality in deeply sedated brain-injured patientsinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleUniversity 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.University Denis Diderot. Beaujon Hospital. Department of Anesthesiology and Intensive Care Unit. Clichy, France.University Paris Descartes. Hotel Dieu Hospital. Assistance Publique Hôpitaux de Paris. Center for Clinical Epidemiology. Paris, France.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.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.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.University of Versailles Saint-Quentin en Yvelines. Raymond-Poincaré Hospital. Assistance Publique Hôpitaux de Paris. General Intensive Care Unit. Garches, France.University of Versailles Saint-Quentin en Yvelines. Raymond-Poincaré Hospital. Assistance Publique Hôpitaux de Paris. General Intensive Care Unit. Garches, France.University of Versailles Saint-Quentin en Yvelines. Raymond-Poincaré Hospital. Assistance Publique Hôpitaux de Paris. Department of Physiology. Garches, France.University Denis Diderot. Beaujon Hospital. Department of Anesthesiology and Intensive Care Unit. Clichy, France.University of Versailles Saint-Quentin en Yvelines. Raymond-Poincaré Hospital. Assistance Publique Hôpitaux de Paris. General Intensive Care Unit. Garches, France.Institut Pasteur. Laboratory of Human Histopathology and Animal Models. Paris, France.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.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.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.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.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.Brain injuryBrainstem dysfunctionCough reflexCritical careDeep sedationNeurological examinationNeuroprognosisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZLICENSElicense.txtlicense.txttext/plain; charset=utf-83099https://www.arca.fiocruz.br/bitstream/icict/45751/1/license.txt586c046dcfeef936e32f0323bb9a47c0MD51ORIGINALEarly_Cassia_Righy_etal_INI_2020.pdfEarly_Cassia_Righy_etal_INI_2020.pdfapplication/pdf1109232https://www.arca.fiocruz.br/bitstream/icict/45751/2/Early_Cassia_Righy_etal_INI_2020.pdf52cca02c3dc9bdc34a22625219fcbb0cMD52TEXTEarly_Cassia_Righy_etal_INI_2020.pdf.txtEarly_Cassia_Righy_etal_INI_2020.pdf.txtExtracted 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dc.title.pt_BR.fl_str_mv Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients
title Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients
spellingShingle Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients
Kandelman, Stanislas
Brain injury
Brainstem dysfunction
Cough reflex
Critical care
Deep sedation
Neurological examination
Neuroprognosis
title_short Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients
title_full Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients
title_fullStr Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients
title_full_unstemmed Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients
title_sort Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients
author Kandelman, Stanislas
author_facet Kandelman, Stanislas
Allary, Jérémy
Porcher, Raphael
Righy, Cássia
Valdez, Clarissa Francisca
Rasulo, Frank
Heming, Nicholas
Moneger, Guy
Azabou, Eric
Savary, Guillaume
Annane, Djillali
Chretien, Fabrice
Latronico, Nicola
Bozza, Fernando Augusto
Rohaut, Benjamin
Sharshar, Tarek
author_role author
author2 Allary, Jérémy
Porcher, Raphael
Righy, Cássia
Valdez, Clarissa Francisca
Rasulo, Frank
Heming, Nicholas
Moneger, Guy
Azabou, Eric
Savary, Guillaume
Annane, Djillali
Chretien, Fabrice
Latronico, Nicola
Bozza, Fernando Augusto
Rohaut, Benjamin
Sharshar, Tarek
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Kandelman, Stanislas
Allary, Jérémy
Porcher, Raphael
Righy, Cássia
Valdez, Clarissa Francisca
Rasulo, Frank
Heming, Nicholas
Moneger, Guy
Azabou, Eric
Savary, Guillaume
Annane, Djillali
Chretien, Fabrice
Latronico, Nicola
Bozza, Fernando Augusto
Rohaut, Benjamin
Sharshar, Tarek
dc.subject.en.pt_BR.fl_str_mv Brain injury
Brainstem dysfunction
Cough reflex
Critical care
Deep sedation
Neurological examination
Neuroprognosis
topic Brain injury
Brainstem dysfunction
Cough reflex
Critical care
Deep sedation
Neurological examination
Neuroprognosis
description 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.
publishDate 2020
dc.date.issued.fl_str_mv 2020
dc.date.accessioned.fl_str_mv 2021-01-19T21:00:41Z
dc.date.available.fl_str_mv 2021-01-19T21:00:41Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
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status_str publishedVersion
dc.identifier.citation.fl_str_mv KANDELMAN, Stanislas et al. Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients. PeerJ, v. 8, p. 1-16, 2020
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/45751
dc.identifier.issn.pt_BR.fl_str_mv 2167-8359
dc.identifier.doi.none.fl_str_mv 10.7717/peerj.10326
identifier_str_mv KANDELMAN, Stanislas et al. Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients. PeerJ, v. 8, p. 1-16, 2020
2167-8359
10.7717/peerj.10326
url https://www.arca.fiocruz.br/handle/icict/45751
dc.language.iso.fl_str_mv eng
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dc.publisher.none.fl_str_mv PeerJ
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collection Repositório Institucional da FIOCRUZ (ARCA)
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