Early Clinical and Electrophysiological Brain Dysfunction Is Associated With ICU Outcomes in COVID-19 Critically Ill Patients With Acute Respiratory Distress Syndrome: A Prospective Bicentric Observational Study*

医学 谵妄 彗差(光学) 四分位间距 急性呼吸窘迫综合征 麻醉 镇静 观察研究 重症监护室 中止 前瞻性队列研究 重症监护 脑电图 突发抑制 儿科 内科学 重症监护医学 精神科 物理 光学
作者
Sarah Benghanem,Alain Cariou,Jean‐Luc Diehl,Angela Marchi,Julien Charpentier,Jean Loup Augy,Caroline Hauw‐Berlemont,Martine Gavaret,Frédéric Pène,Jean‐Paul Mira,Tarek Sharshar,Bertrand Hermann
出处
期刊:Critical Care Medicine [Lippincott Williams & Wilkins]
卷期号:50 (7): 1103-1115 被引量:4
标识
DOI:10.1097/ccm.0000000000005491
摘要

Describe the prevalence of acute cerebral dysfunction and assess the prognostic value of an early clinical and electroencephalography (EEG) assessment in ICU COVID-19 patients.Prospective observational study.Two tertiary critical care units in Paris, France, between April and December 2020.Adult critically ill patients with COVID-19 acute respiratory distress syndrome.Neurologic examination and EEG at two time points during the ICU stay, first under sedation and second 4-7 days after sedation discontinuation.Association of EEG abnormalities (background reactivity, continuity, dominant frequency, and presence of paroxystic discharges) with day-28 mortality and neurologic outcomes (coma and delirium recovery). Fifty-two patients were included, mostly male (81%), median (interquartile range) age 68 years (56-74 yr). Delayed awakening was present in 68% of patients (median awakening time of 5 d [2-16 d]) and delirium in 74% of patients who awoke from coma (62% of mixed delirium, median duration of 5 d [3-8 d]). First, EEG background was slowed in the theta-delta range in 48 (93%) patients, discontinuous in 25 patients (48%), and nonreactive in 17 patients (33%). Bifrontal slow waves were observed in 17 patients (33%). Early nonreactive EEG was associated with lower day-28 ventilator-free days (0 vs 16; p = 0.025), coma-free days (6 vs 22; p = 0.006), delirium-free days (0 vs 17; p = 0.006), and higher mortality (41% vs 11%; p = 0.027), whereas discontinuous background was associated with lower ventilator-free days (0 vs 17; p = 0.010), coma-free days (1 vs 22; p < 0.001), delirium-free days (0 vs 17; p = 0.001), and higher mortality (40% vs 4%; p = 0.001), independently of sedation and analgesia.Clinical and neurophysiologic cerebral dysfunction is frequent in COVID-19 ARDS patients. Early severe EEG abnormalities with nonreactive and/or discontinuous background activity are associated with delayed awakening, delirium, and day-28 mortality.

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