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Sergeenko EV, Belousova OB, Pilipenko YV. [Diagnostic criteria for prolonged and chronic disturbances of consciousness after aneurysmal subarachnoid hemorrhages]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:117-121. [PMID: 39169590 DOI: 10.17116/neiro202488041117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
BACKGROUND In recent years, prolonged states of impaired consciousness became widespread among patients with aneurysmal subarachnoid hemorrhage. Treatment and maintenance of vital functions in such patients represent a complex medical, economic and social problem. In this regard, searching for the causes of prolonged states of impaired consciousness and predicting the outcomes are important. OBJECTIVE To analyze available literature data on prevention and treatment of prolonged states of impaired consciousness after aneurysmal subarachnoid hemorrhage. RESULTS We reviewed the PubMed database using the keywords «unresponsive wakefulness syndrome», «persistent vegetative state2, «minimal consciousness state» and «outcome of subarachnoid hemorrhage». Only 4 reports devoted to the causes and treatment outcomes in patients with prolonged impairment of consciousness after aneurysmal subarachnoid hemorrhage were found. At the same time, patients with aneurysmal subarachnoid hemorrhage comprise up to 11% among all cases of prolonged states of impaired consciousness. Examination, management and treatment of patients with prolonged impairment of consciousness after aneurysmal subarachnoid hemorrhage are carried out according to general principles without taking into account specific etiological and pathogenetic factors. CONCLUSION Increased number of patients with prolonged impairment of consciousness after aneurysmal subarachnoid hemorrhage necessitates analysis of etiopathogenesis and outcomes of these disorders based on modern clinical, instrumental and laboratory assessment of the brain.
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Hoh BL, Ko NU, Amin-Hanjani S, Chou SHY, Cruz-Flores S, Dangayach NS, Derdeyn CP, Du R, Hänggi D, Hetts SW, Ifejika NL, Johnson R, Keigher KM, Leslie-Mazwi TM, Lucke-Wold B, Rabinstein AA, Robicsek SA, Stapleton CJ, Suarez JI, Tjoumakaris SI, Welch BG. 2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage: A Guideline From the American Heart Association/American Stroke Association. Stroke 2023; 54:e314-e370. [PMID: 37212182 DOI: 10.1161/str.0000000000000436] [Citation(s) in RCA: 132] [Impact Index Per Article: 132.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
AIM The "2023 Guideline for the Management of Patients With Aneurysmal Subarachnoid Hemorrhage" replaces the 2012 "Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage." The 2023 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with aneurysmal subarachnoid hemorrhage. METHODS A comprehensive search for literature published since the 2012 guideline, derived from research principally involving human subjects, published in English, and indexed in MEDLINE, PubMed, Cochrane Library, and other selected databases relevant to this guideline, was conducted between March 2022 and June 2022. In addition, the guideline writing group reviewed documents on related subject matter previously published by the American Heart Association. Newer studies published between July 2022 and November 2022 that affected recommendation content, Class of Recommendation, or Level of Evidence were included if appropriate. Structure: Aneurysmal subarachnoid hemorrhage is a significant global public health threat and a severely morbid and often deadly condition. The 2023 aneurysmal subarachnoid hemorrhage guideline provides recommendations based on current evidence for the treatment of these patients. The recommendations present an evidence-based approach to preventing, diagnosing, and managing patients with aneurysmal subarachnoid hemorrhage, with the intent to improve quality of care and align with patients' and their families' and caregivers' interests. Many recommendations from the previous aneurysmal subarachnoid hemorrhage guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Nie M, Fu J, Sun J, Wang H. Percutaneous Mechanical Thrombectomy for Acute Symptomatic Iliofemoral Deep Venous Thrombosis Patients With Recent Aneurysmal Subarachnoid Hemorrhage. J Endovasc Ther 2022; 30:250-258. [PMID: 35229685 DOI: 10.1177/15266028221079773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate the efficacy, safety, and mid-term outcomes of percutaneous mechanical thrombectomy (PMT) for acute symptomatic iliofemoral deep venous thrombosis (DVT) patients with recent (within 4 weeks) aneurysmal subarachnoid hemorrhage (aSAH). MATERIALS AND METHODS From January 2016 to February 2020, 11 acute symptomatic iliofemoral DVT patients with a recent history of aSAH were enrolled in this study. All patients had a history of aneurysm ligation or clipping previously, computed tomography (CT) scans revealed ventricular hemorrhage had been absorbed obviously and no residual aneurysm. The mean time of DVT onset after aSAH ictus was 19.2±4.5 days, and the mean Glasgow score was 6.8 ± 0.7 (range, 6-8). These patients underwent PMT with an 8 French Aspirex®S device (Straub Medical AG, Wangs, Switzerland), subsequent stenting was performed to relieve the underlying stenosis, followed by anticoagulation alone. The procedure-related complications were assessed after intervention. The follow-ups were conducted up to 1 year, the patency was evaluated via duplex ultrasonography, and the incidence of post-thrombotic syndrome (PTS) was evaluated using the Villalta scale. RESULTS Grade III (>90%) clearance was achieved in all 11 patients. Stenting was performed in 7 patients (63.6%). There were no cerebral rebleeding events or other severe complications except 1 puncture site bleeding during treatment. A total of 90.9% (10 of 11) of patients were alive at the 12 month follow-up, and 7 patients achieved a good functional outcome. At the 1 year follow-up, there was 1 patient (10%) with mild PTS. The ultrasound showed that the patency of the iliofemoral veins was 100%, and femoral valvular incompetence was observed in 1 patient. CONCLUSION Percutaneous mechanical thrombectomy seems to be a feasible and safe treatment for acute iliofemoral DVT in selected patients with recent aSAH, and it shows promising results in restoring patency and reducing the risk of PTS.
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Affiliation(s)
- Menglin Nie
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jian Fu
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jianming Sun
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Haiyang Wang
- Department of Abdominal Wall, Hernia and Vascular Surgery, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Perez P, Valente M, Hermann B, Sitt J, Faugeras F, Demeret S, Rohaut B, Naccache L. Auditory Event-Related "Global Effect" Predicts Recovery of Overt Consciousness. Front Neurol 2021; 11:588233. [PMID: 33488494 PMCID: PMC7819971 DOI: 10.3389/fneur.2020.588233] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/03/2020] [Indexed: 01/23/2023] Open
Abstract
Objective: To explore whether the presence of an event-related potential (ERP) "global effect" (GE+)-that corresponds to a correlate of conscious processing in the local-global auditory task-predicts behaviorally overt consciousness recovery in a large cohort of patients suffering from disorders of consciousness (DOC). Methods: We conducted a prospective study on all DOC patients evaluated during the 2009-2018 period. Behavioral examination included Coma Recovery Scale-Revised (CRS-R) scores and bedside high-density EEG recordings. Consciousness recovery was evaluated at 6 months by a structured phone interview. The predictive value of a GE+ was calculated both on survivors and on all patients. Results: A total of 236 patients with a documented outcome and technically valid EEG recordings could be included. Among them, 66 patients had a GE+ status (28%). Presence of GE+ predicted behaviorally overt consciousness recovery in survivors with high specificity (Sp = 84%) and high positive predictive value (PPV = 80%) but with low sensitivity (Se = 35%) and low negative predictive value (NPV = 42%). Positive likelihood ratio (LR+) of GE+ was superior to LR+ of initial clinical status and of ERP effect indexing unconscious auditory processing [local effect (LE)]. Interpretation: Our results demonstrate that the presence of a bedside ERP GE+ is highly predictive of behaviorally overt consciousness recovery in DOC patients, regardless of the delay, of behavioral status, and of the etiology of brain dysfunction. However, the absence of this effect is not a reliable predictor of negative outcome. This study provides Class III evidence that the presence of an ERP "global effect" predicts consciousness recovery in DOC patients.
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Affiliation(s)
- Pauline Perez
- PICNIC Lab Team, INSERM, U 1127, CNRS UMR 7225, Faculté de Médecine de Sorbonne Université, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Hôpital Pitié-Salpêtrière, Paris, France
| | - Mélanie Valente
- PICNIC Lab Team, INSERM, U 1127, CNRS UMR 7225, Faculté de Médecine de Sorbonne Université, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Hôpital Pitié-Salpêtrière, Paris, France.,Assistance Publique Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Department of Clinical Neurophysiology, Paris, France
| | - Bertrand Hermann
- PICNIC Lab Team, INSERM, U 1127, CNRS UMR 7225, Faculté de Médecine de Sorbonne Université, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jacobo Sitt
- PICNIC Lab Team, INSERM, U 1127, CNRS UMR 7225, Faculté de Médecine de Sorbonne Université, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Hôpital Pitié-Salpêtrière, Paris, France
| | - Frédéric Faugeras
- Assistance Publique Hôpitaux de Paris (APHP), Hôpital Henri-Mondor, Department of Neurology, Créteil, France
| | - Sophie Demeret
- Assistance Publique Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Benjamin Rohaut
- PICNIC Lab Team, INSERM, U 1127, CNRS UMR 7225, Faculté de Médecine de Sorbonne Université, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Hôpital Pitié-Salpêtrière, Paris, France.,Assistance Publique Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France.,Faculté de Médecine Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Lionel Naccache
- PICNIC Lab Team, INSERM, U 1127, CNRS UMR 7225, Faculté de Médecine de Sorbonne Université, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Hôpital Pitié-Salpêtrière, Paris, France.,Assistance Publique Hôpitaux de Paris (APHP), Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France.,Faculté de Médecine Pitié-Salpêtrière, Sorbonne Université, Paris, France
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5
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Nussbaum ES, Mikoff N, Paranjape GS. Cognitive deficits among patients surviving aneurysmal subarachnoid hemorrhage. A contemporary systematic review. Br J Neurosurg 2020; 35:384-401. [PMID: 33345644 DOI: 10.1080/02688697.2020.1859462] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Subarachnoid hemorrhage (SAH) is associated with high rates of morbidity, including neurological and cognitive deficits that may be difficult to identify and quantify. This review provides an update on the cognitive deficits that may result from spontaneous aneurysmal SAH (aSAH) and identifies factors that may help predict and manage these deficits at discharge and thereafter. MATERIALS AND METHODS We conducted a systematic review of PubMed and Google Scholar to identify studies published between 2010 and 2019 that assessed cognitive deficits at discharge and during follow-up in patients with aSAH. Full-text articles were assessed for information regarding cognitive testing and factors that may be associated with functional outcomes in this population. RESULTS We reviewed 65 studies published since 2010 that described the cognitive deficits associated with non-traumatic aSAH. Such deficits may impact functional outcomes, quality of life, and return to work and may result in cognitive impairments, such as memory difficulties, speech problems, and psychiatric disorders. CONCLUSIONS Patients with aSAH, even those that appear normal at the time of hospital discharge, may harbor cognitive deficits that are difficult to detect, yet can interfere with daily functioning. Further research is needed to provide additional information and to identify stronger correlations to be used in the identification, treatment, and amelioration of long-term cognitive deficits in aSAH patients, including those who are discharged with good clinical outcomes scores.
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Affiliation(s)
- Eric S Nussbaum
- Department of Neurosurgery, National Brain Aneurysm & Tumor Center, United Hospital, Twin Cities, MN, USA
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Hakiki B, Pancani S, Draghi F, Portaccio E, Tofani A, Binazzi B, Anna Maria R, Scarpino M, Macchi C, Cecchi F. Decannulation and improvement of responsiveness in patients with disorders of consciousness. Neuropsychol Rehabil 2020; 32:520-536. [PMID: 33100115 DOI: 10.1080/09602011.2020.1833944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Decannulation is a rehabilitation milestone in patients with Disorders of Consciousness (DoC). investigate the relationship between decannulation and improvement of responsiveness (IR) in DoC. 236 tracheostomized patients with severe Acquired Brain Injury and DoC admitted in the Intensive Rehabilitation Unit were retrospectively included. They received personalized interdisciplinary rehabilitation. At discharge, IR was evaluated. The association between IR and demographic/clinical data was investigated using a logistic regression analysis, both in the Unresponsive Wakefulness Syndrome (UWS) and Minimal Consciousness State (MCS) group, divided according to their Coma Recovery Scale-Revised score at admission. In the UWS group (N = 107), only decannulation was associated with IR at discharge (OR: 5.94, CI: 2.08-16.91, p = .001). In the MCS group (N = 129) time post-injury (OR: 0.983, CI: 0.97-0.99, p = .012) and decannulation were associated with IR at discharge (OR: 17.9, CI: 6.39-50.13, p < .001). Decannulation and IR were found to be strongly related, independently from the initial clinical state. While the retrospective nature of the study could not exclude that decannulation may be a consequence of a spontaneous recovery, the obtained results may disclose its potential influence on the clinical history of patients with DoC.
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Affiliation(s)
- Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | - Emilio Portaccio
- SOC Neurologia, Ospedale San Giovanni di Dio, Firenze, AUSL Toscana Centro, Florence, Italy
| | | | | | | | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, SODc Neurofisiopatologia, AOU Careggi, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Developing an instrument for an early prediction model of long-term functional outcomes in people with acquired injuries of the central nervous system: protocol and methodological aspects. Neurol Sci 2020; 42:2441-2446. [PMID: 33078248 PMCID: PMC8159777 DOI: 10.1007/s10072-020-04821-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/10/2020] [Indexed: 11/24/2022]
Abstract
Severe acquired brain injury (ABI) is a major cause of long-term disability and is the main determinant of health and societal costs. Early identification of favourable long-term recovery would allow personalized rehabilitative programs and better health care resources allocation. In light of the higher survival rate from intensive care units (ICU) in recent years, there is a growing need for early prognostication markers of functional recovery; to date, these data have been mainly collected at rehabilitation unit admission and not during the acute phase. We present the protocol and methodology to develop prediction models in people with severe acquired brain injury (GCS at admission to ICU < 8) for the functional and cognitive outcome at 12 months from the event. Predictors will be collected during the acute stage. Participants will be recruited within the first 72 h from the event in the ICUs of two teaching hospitals (Padova and Treviso). Participants will be followed up at discharge from ICU, admission and discharge from Neurorehabilitation and after 12 months from the event. Clinical and functional scales, electroencephalography, evoked potentials, magnetic resonance imaging and serological markers will be entered into a digital registry. Survival will be estimated using the Cox proportional hazard model. A multivariate prediction model will be developed for each of the functional and cognitive outcomes at 12 months from the event.
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8
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Pignolo L, Basta G, Carozzo S, Bilotta M, Todaro MR, Serra S, Ciancarelli I, Tonin P, Cerasa A. A body-weight-supported visual feedback system for gait recovering in stroke patients: A randomized controlled study. Gait Posture 2020; 82:287-293. [PMID: 33002839 DOI: 10.1016/j.gaitpost.2020.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to determine the effectiveness of a novel body-weight-supported (BWS) gait training system with visual feedback, called Copernicus® (Rehalife, Italy). This computerized device provides comfortable, regular and repeatable locomotion in hemiplegic patients. Through visual real-time monitoring of gait parameters, patients are trained to transfer weight loading alternately on both feet. DESIGN A single-blind, randomized controlled study. A single center used a computer-generated randomization code to allocate treatments. SETTING Intensive rehabilitation unit (IRU) at the Institute S. Anna (Italy). PARTICIPANTS 63 first-ever stroke patients (39 men, age: 66.1 ± 9.6 years; 61.6 % with left-sided lesion) randomly distributed into three demographically/clinically matched groups. TREATMENTS All groups were treated five times a week for 2 -h sessions for six consecutive weeks. The first group ("control") underwent a conventional physical therapy; the second group performed advanced BWS gait training sessions without visual feedback (Experimental VF- group); whereas the third group used BWS with visual feedback stimulation (Experimental VF+ group). MAIN OUTCOME MEASURES Absolute changes were recorded using conventional clinical scales and kinematic measurement of static gait balance from baseline to follow-up. RESULTS Significant interaction Group*Time effects scales (F2,126 = 5.1, p-level = 0.005, η²p = 0.25; F2,126 = 4.7, p-level = 0.007, η²p = 0.19; respectively) were detected in the Functional Independence Measure and Tinetti-Balance scales. Post hoc analysis demonstrated that the recovery of motor functioning was greater for the VF + group with respect to other groups (all p's ≤ 0.001). A similar pattern of findings was also obtained with a stabilometric analysis, demonstrating a better clinical improvement in static balance after VF + treatment. CONCLUSION The proposed advanced rehabilitation system with visual feedback was more effective in improving gait recovery with respect to conventional and high-tech therapies without a sensor feedback.
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Affiliation(s)
| | | | | | | | | | | | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | | | - Antonio Cerasa
- S. Anna Institute, 88900, Crotone, Italy; Institute for Biomedical Research and Innovation, National Research Council, (IRIB-CNR), 87050, Mangone, CS, Italy.
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9
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Hakiki B, Draghi F, Pancani S, Portaccio E, Grippo A, Binazzi B, Tofani A, Scarpino M, Macchi C, Cecchi F. Decannulation After a Severe Acquired Brain Injury. Arch Phys Med Rehabil 2020; 101:1906-1913. [PMID: 32428445 DOI: 10.1016/j.apmr.2020.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify the effect of some clinical characteristics of severe acquired brain injury (sABI) patients on decannulation success during their intensive rehabilitation unit (IRU) stay. DESIGN Nonconcurrent cohort study. SETTING Don Gnocchi Foundation Institute. PARTICIPANTS Patients (N=351) with sABI and tracheostomy were retrospectively selected from the database of the IRU of the Don Gnocchi Foundation Institute. MAIN OUTCOME MEASURES Potential predictors of decannulation were screened from variables collected at admission during clinical examination, conducted by trained and experienced examiners. The association between clinical characteristics and decannulation status was investigated through a Cox regression model. Kaplan-Meier curves were then created for time-event analysis. RESULTS Among the patients (mean age, 64.1±15.5y), 54.1% were decannulated during their IRU stay. Absence of pulmonary infections (P<.001), sepsis (P=.001), tracheal alteration at the fibrobronchoscopy examination (P=.004) and a higher Coma Recovery Scale-Revised (CRS-R) score (P<.001) or a better state of consciousness at admission (P=.001) were associated with a higher probability of decannulation. CONCLUSIONS Fibrobronchoscopy assessment of patency of airways and accurate evaluation of the state of consciousness using the CRS-R are relevant in this setting of care to better identify patients who are more likely to have the tracheostomy tube removed. These results may help clinicians choose the appropriate timing and intensity of rehabilitation interventions and plan for discharge.
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Affiliation(s)
- Bahia Hakiki
- Don Carlo Gnocchi Foundation, IRCSS, Florence, Italy
| | | | | | - Emilio Portaccio
- SOC Neurology, San Giovanni di Dio Hospital, Firenze, AUSL Toscana Center, Florence, Italy
| | | | | | - Ariela Tofani
- Don Carlo Gnocchi Foundation, IRCSS, Florence, Italy
| | | | - Claudio Macchi
- Don Carlo Gnocchi Foundation, IRCSS, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Wang Y, Gao Y, Lu M, Liu Y. Long-term functional prognosis of patients with aneurysmal subarachnoid hemorrhage treated with rehabilitation combined with hyperbaric oxygen: Case-series study. Medicine (Baltimore) 2020; 99:e18748. [PMID: 32011457 PMCID: PMC7220398 DOI: 10.1097/md.0000000000018748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The long-term prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH) has received increasing attention in recent years. Hyperbaric oxygen and rehabilitation are already used in clinical treatment of patients with aSAH, but it is unclear whether it can improve the long-term prognosis of patients postoperation. The purpose of this study was to evaluate the long-term prognosis and prognostic factors associated with combined rehabilitation and hyperbaric oxygen therapy for patients with aSAH.Information were retrospectively collected from patients with aSAH treated from October 2014 to July 2017, including demographics, history of hypertension, Hunt-Hess Grade at the time of onset, location of aneurysm, surgical treatment, status of delayed cerebral ischemia and tracheotomy, level of consciousness impairment (Glasgow Coma scale [GCS], neurologic function damage (National Institutes of Health Stroke Scale [NIHSS]), status of hydrocephalus, time of initial hyperbaric oxygen and rehabilitation therapy, as well as duration and frequency of hyperbaric oxygen therapy, and so on. Long-term functional prognosis was measured by modified Rankin scale (mRS), and mRS ≤3 was defined as good prognosis. Univariate and multivariate logistic regression were used to analyze predictors associated with poor prognosis.A total of 44 patients with aSAH were enrolled, and 25 patients (56.8%) had a good functional prognosis 6 months after disease onset. Univariate analysis showed age (P = .028), hyperbaric oxygen and rehabilitation start time (P = .039), NIHSS (P = .000), hydrocephalus (P = .024), frequency of hyperbaric oxygen therapy (P = .016), GCS ≤8 points (P = .000), and tracheotomy (P = .007) were associated with prognosis. Multivariate logistic regression analysis showed that only a higher NIHSS score was an independent predictor of poor prognosis (odds ratio = 1.59; 95% confidence interval, 1.10-2.30).More than 50% of patients with aSAH can achieve a good functional prognosis after combined rehabilitation and hyperbaric oxygen therapy. The severity of neurological impairment before treatment is closely related to poor prognosis.
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11
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Mayer SA, Aldrich EF, Bruder N, Hmissi A, Macdonald RL, Viarasilpa T, Marr A, Roux S, Higashida RT. Thick and Diffuse Subarachnoid Blood as a Treatment Effect Modifier of Clazosentan After Subarachnoid Hemorrhage. Stroke 2019; 50:2738-2744. [PMID: 31394993 DOI: 10.1161/strokeaha.119.025682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background and Purpose- Clazosentan, an endothelin receptor antagonist, has been shown to reduce angiographic vasospasm and vasospasm-related morbidity after aneurysmal subarachnoid hemorrhage (SAH), although no effect on long-term functional outcome has been demonstrated. Thick clot on initial computed tomography is associated with an increased risk of vasospasm and delayed cerebral ischemia. In this post hoc analysis, we hypothesized that use of clazosentan in this subpopulation would provide stronger benefit. Methods- We analyzed SAH patients enrolled in the CONSCIOUS-2 and CONSCIOUS-3 studies (Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage) and compared the effects of clazosentan 5 mg/h, 15 mg/h, and placebo starting the day after aneurysm repair. The analysis was performed separately based on the presence or absence of thick (≥4 mm) and diffuse (≥3 cisterns) SAH on admission computed tomography. The primary composite end point was all-cause mortality and vasospasm-related morbidity at 6 weeks, and the main secondary end point was the extended Glasgow Outcome Scale at 3 months, adjusted for admission clinical grade. Results- Of 1718 randomized patients, 919 (53%) had thick and diffuse SAH. The primary composite end point in this group occurred in 36% of placebo-treated patients (n=294), 30% patients treated with clazosentan 5 mg/h (n=514; relative risk, 0.82; 95% CI, 0.67-0.99), and 19% patients treated with clazosentan 15 mg/h (n=111; relative risk, 0.54; 95% CI, 0.36-0.80). Despite this, death or poor functional outcome (Glasgow Outcome Scale ≤4) occurred in 33% of placebo-treated patients, 34% of patients treated with clazosentan 5 mg/h (relative risk 1.02; 95% CI, 0.84-1.23), and 35% of patients treated with clazosentan 15 mg/h (relative risk 1.14; 95% CI, 0.88-1.48). Conclusions- In an enriched population with thick and diffuse SAH, clazosentan at a dose of 5 and 15 mg/h was able to significantly reduce vasospasm-related morbidity in a dose-dependent manner. The absence of an effect on long-term functional status likely reflects the complexity and multiplicity of factors that contribute to poor outcome after SAH. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00558311; NCT00940095.
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Affiliation(s)
- Stephan A Mayer
- From the Department of Neurology, Henry Ford Hospital, Detroit, MI (S.A.M., T.V.)
| | | | - Nicolas Bruder
- Hopital de la Timone-Aix-Marseille Université, France (N.B.)
| | - Abdel Hmissi
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland (A.H., A.M., S.R.)
| | - R Loch Macdonald
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, ON, Canada (R.L.M.)
| | - Tanuwong Viarasilpa
- From the Department of Neurology, Henry Ford Hospital, Detroit, MI (S.A.M., T.V.).,Division of Critical Care, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.V.)
| | - Angelina Marr
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland (A.H., A.M., S.R.)
| | - Sebastien Roux
- Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland (A.H., A.M., S.R.)
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Predictors for Functional Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage Who Completed In-Hospital Rehabilitation in a Single Institution. J Stroke Cerebrovasc Dis 2019; 28:1943-1950. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 02/21/2019] [Accepted: 03/16/2019] [Indexed: 11/24/2022] Open
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13
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Lucca LF, Lofaro D, Pignolo L, Leto E, Ursino M, Cortese MD, Conforti D, Tonin P, Cerasa A. Outcome prediction in disorders of consciousness: the role of coma recovery scale revised. BMC Neurol 2019; 19:68. [PMID: 30999877 PMCID: PMC6472098 DOI: 10.1186/s12883-019-1293-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/31/2019] [Indexed: 01/05/2023] Open
Abstract
Background To evaluate the utility of the revised coma remission scale (CRS-r), together with other clinical variables, in predicting emergence from disorders of consciousness (DoC) during intensive rehabilitation care. Methods Data were retrospectively extracted from the medical records of patients enrolled in a specialized intensive rehabilitation unit. 123 patients in a vegetative state (VS) and 57 in a minimally conscious state (MCS) were included and followed for a period of 8 weeks. Demographical and clinical factors were used as outcome measures. Univariate and multivariate Cox regression models were employed for examining potential predictors for clinical outcome along the time. Results VS and MCS groups were matched for demographical and clinical variables (i.e., age, aetiology, tracheostomy and route of feeding). Within 2 months after admission in intensive neurorehabilitation unit, 3.9% were dead, 35.5% had a full recovery of consciousness and 66.7% remained in VS or MCS. Multivariate analysis demonstrated that the best predictor of functional improvement was the CRS-r scores. In particular, patients with values greater than 12 at admission were those with a favourable likelihood of emergence from DoC. Conclusions Our study highlights the role of the CRS-r scores for predicting a short-term favorable outcome.
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Affiliation(s)
- Lucia Francesca Lucca
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy.
| | - Danilo Lofaro
- Dipartimento di Ingegneria Meccanica, Energetica e Gestionale - DIMEG, UNICAL, Arcavata di Rende (CS), Rende, Italy.,Kidney and Transplantation Research Center, Annunziata Hospital, Cosenza, Italy
| | - Loris Pignolo
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Elio Leto
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Maria Ursino
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Maria Daniela Cortese
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Domenico Conforti
- Kidney and Transplantation Research Center, Annunziata Hospital, Cosenza, Italy
| | - Paolo Tonin
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy
| | - Antonio Cerasa
- S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), 88900, Crotone, Italy. .,Neuroimaging Unit, IBFM-CNR, 88100, Catanzaro, Italy.
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Wade DT. How many patients in a prolonged disorder of consciousness might need a best interests meeting about starting or continuing gastrostomy feeding? Clin Rehabil 2018; 32:1551-1564. [PMID: 29779405 DOI: 10.1177/0269215518777285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: To estimate the number of people in a prolonged disorder of consciousness (PDOC) who may need a formal best interests decision-making process to consider starting and/or continuing life-sustaining treatment each year in the population of a developed country. METHOD: Identification of studies on people with a PDOC giving information about incidence, and/or prevalence, and/or cause, and/or location of long-term care. Sources included systematic reviews, a new search of MEDLINE (April 2018), and a personal collection of papers. Validating information was sought from existing data on services. RESULTS: There are few epidemiologically sound studies, most having bias and/or missing information. The best estimate of incidence of PDOC due to acute onset disease is 2.6/100,000/year; the best estimate of prevalence is between 2.0 and 5.0/100,000. There is evidence that prevalence in the Netherlands is about 10% of that in other countries. The commonest documented causes are cerebral hypoxia, stroke, traumatic brain injury, and tumours. There is some evidence suggesting that dementia is a common cause, but PDOC due to progressive disorders has not been studied systematically. Most people receive long-term care in nursing homes, but a significant proportion (10%-15%) may be cared for at home. CONCLUSION: Each year, about 5/100,000 people will enter a prolonged state of unconsciousness from acute onset and progressive brain damage; and at any one time, there may be 5/100,000 people in that state. However, the evidence is very limited in quality and quantity. The numbers may be greater.
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Affiliation(s)
- Derick T Wade
- 1 OxINMAHR, and Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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15
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Lopez-Rolon A, Vogler J, Howell K, Shock J, Czermak S, Heck S, Straube A, Bender A. Severe disorders of consciousness after acquired brain injury: A single-centre long-term follow-up study. NeuroRehabilitation 2018; 40:509-517. [PMID: 28222568 DOI: 10.3233/nre-171438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To assess long-term clinical outcome, functional independence and health-related quality of life (HRQOL) in acquired brain injury (ABI) patients with a disorder of consciousness at admission to inpatient rehabilitation. METHODS We selected patients from a cohort of ABI patients from a single centre. In addition to mortality, we measured level of consciousness with the Coma Remission Scale, functional independence with the Barthel Index, as well as generic and condition-specific HRQOL with the EQ5D and the "Quality of Life after Brain Injury" (QOLIBRI) respectively. RESULTS Half of the obtained sample had died by follow-up. Survivors were younger at onset, in a minimally conscious state (MCS) at admission and had spent longer time in rehabilitation. Patients in a MCS were more likely to survive, and be in a state better than MCS over the follow-up time than patients with an unresponsive wakefulness syndrome (UWS). A small proportion of patients with UWS at admission emerged from MCS at follow-up. Emergence from MCS was associated with traumatic brain injury (TBI) and higher functional independence. CONCLUSION Clinical outcome is mostly concordant with previous findings. Survivors' rehabilitation duration suggest revision of current standards. HRQOL results indicate a correlation with functional independence and that condition-specific HRQOL should not be neglected.
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Affiliation(s)
| | - Jana Vogler
- Department of Neurology, University of Munich, Munich, Germany
| | - Kaitlen Howell
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Jonathan Shock
- Department of Mathematics and Applied Mathematics, University of Cape Town, Cape Town, South Africa
| | - Stefan Czermak
- Department of Neurology, University of Munich, Munich, Germany
| | - Suzette Heck
- Department of Neurology, University of Munich, Munich, Germany
| | - Andreas Straube
- Department of Neurology, University of Munich, Munich, Germany
| | - Andreas Bender
- Department of Neurology, University of Munich, Munich, Germany.,Department of Neurology, Therapiezentrum Burgau, Burgau, Germany
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Techniques of cognitive rehabilitation in patients with disorders of consciousness: a systematic review. Neurol Sci 2018; 39:641-645. [PMID: 29305661 DOI: 10.1007/s10072-017-3235-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/18/2017] [Indexed: 12/17/2022]
Abstract
Acquired brain injury can produce severe impairments of alertness, cognition, behavior, and, sometimes, an impairment of consciousness. Several studies defined the criteria to distinguish the different level of disorders of consciousness (DOC) and many tools to evaluate awareness, alertness, and response to stimuli were created. The aim of this review is to assess the advanced research of rehabilitative protocols and which rehabilitative techniques are used in the care of DOC patients.
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von Vogelsang AC, Thelin EP, Hakim R, Svensson M. Health-Related Quality of Life Dynamics 2 Years Following Aneurysmal Subarachnoid Hemorrhage: A Prospective Cohort Study Using EQ-5D. Neurosurgery 2017; 81:650-658. [PMID: 28368438 DOI: 10.1093/neuros/nyx059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 01/25/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies have shown that aneurysmal subarachnoid hemorrhage (aSAH) affects health-related quality of life (HRQoL) to a large extent. However, longitudinal studies on HRQoL after aSAH are scarce, and there is limited knowledge whether different HRQoL dimension scores change over time, and if so, if the scoring differs from results from the general population. OBJECTIVE To evaluate HRQoL dynamics over time, 2 years following aSAH, and compare the results with general population. METHODS In a prospective cohort design, 88 consecutive aSAH patients (85% of eligible) were followed up with the generic HRQoL instrument EQ-5D at 3 time points: 6 months, 1 year, and 2 years after the onset. Data were collected in 2006 to 2009, and the results were compared with a general population sample from the Stockholm Public Health Survey 2006, matched by age and sex. RESULTS Overall HRQoL in the aSAH sample was stationary over time. Improved function was only found in the usual activities dimension (P = .026). HRQoL was most affected in participants reporting comorbidity. Compared with the general population, women in the aSAH sample reported significantly more problems in 4 out of 5 dimensions (mobility, self-care, usual activities, and anxiety/depression). Men in the aSAH sample reported significantly more problems in the usual activities dimension in comparison to the general population. CONCLUSION HRQoL is stationary during the first 2 years following aSAH, and is significantly worse when compared to the general population. Rehabilitation efforts should be initiated shortly after hospitalization.
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Affiliation(s)
- Ann-Christin von Vogelsang
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Eric Peter Thelin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Ramil Hakim
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Svensson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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Perin C, Meroni R, Rega V, Braghetto G, Cerri CG. Parameters Influencing Tracheostomy Decannulation in Patients Undergoing Rehabilitation after severe Acquired Brain Injury (sABI). Int Arch Otorhinolaryngol 2017; 21:382-389. [PMID: 29018503 PMCID: PMC5629091 DOI: 10.1055/s-0037-1598654] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 12/21/2016] [Indexed: 11/06/2022] Open
Abstract
Introduction
Tracheostomy weaning in patients who suffered a severe acquired brain injury is often a challenge and decannulation failures are not uncommon.
Objective
Our study objective is to describe the decannulation failure rate in patients undergoing rehabilitation following a severe acquired brain injury (sABI); to describe the factors associated with a successful tube weaning.
Methods
We conduct a retrospective analysis of charts, consecutively retrieved considering a 3-year window. Variables analyzed were: age, sex, body mass index (BMI), Glasgow Coma Scale (GCS), cause of hospitalization (stroke, trauma, cardiac arrest), date of the pathological event, gap between the index event and the first day of hospitalization, duration of Neurorehabilitation Ward hospitalization, comorbidities, chest morphological alteration, kind of tracheostomy tube used (overall dimension, cap, fenestration), SpO2, presentation and quantification of pulmonary secretion, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP), respiratory frequency and pattern, cardiac frequency, presence of spontaneous cough, cough strength, and blood gas analysis.
Results
We analyzed 45 tracheostomised sABI patients following stroke, trauma, or cardiac arrest. The weaning success percentage was higher in Head Trauma patients and in patients presenting positive spontaneous cough. Failures seem to be associated with presence of secretions and anoxic brain damage. GCS seemed not related to the decannulation outcome.
Conclusions
Parameters that could be used as positive predictors of weaning are: mean expiratory pressure, presence of spontaneous cough, and cough strength. Provoked cough and GCS were not predictive of weaning success.
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Affiliation(s)
- Cecilia Perin
- Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca Ringgold Standard Institution, Milano, Italy
| | - Roberto Meroni
- Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca Ringgold Standard Institution, Milano, Italy
| | - Vincenzo Rega
- Riabilitazione Neurologica, Gruppo Ospedaliero San Donato Ringgold Standard Institution, Milano, Lombardia, Italy
| | - Giacomo Braghetto
- Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca Ringgold Standard Institution, Milano, Italy
| | - Cesare Giuseppe Cerri
- Medicina e Chirurgia, Universita degli Studi di Milano-Bicocca Ringgold Standard Institution, Milano, Italy
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Zanaty M, Chalouhi N, Starke RM, Daou B, Todd M, Bayman E, Torner J, Hasan D. Short-Term Outcome of Clipping Versus Coiling of Ruptured Intracranial Aneurysms Treated by Dual-Trained Cerebrovascular Surgeon: Single-Institution Experience. World Neurosurg 2016; 95:262-269. [DOI: 10.1016/j.wneu.2016.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022]
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20
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Fingelkurts AA, Fingelkurts AA, Bagnato S, Boccagni C, Galardi G. Long-Term (Six Years) Clinical Outcome Discrimination of Patients in the Vegetative State Could be Achieved Based on the Operational Architectonics EEG Analysis: A Pilot Feasibility Study. Open Neuroimag J 2016; 10:69-79. [PMID: 27347266 PMCID: PMC4894941 DOI: 10.2174/1874440001610010069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/06/2016] [Accepted: 04/11/2016] [Indexed: 11/22/2022] Open
Abstract
Electroencephalogram (EEG) recordings are increasingly used to evaluate patients with disorders of consciousness (DOC) or assess their prognosis outcome in the short-term perspective. However, there is a lack of information concerning the effectiveness of EEG in classifying long-term (many years) outcome in chronic DOC patients. Here we tested whether EEG operational architectonics parameters (geared towards consciousness phenomenon detection rather than neurophysiological processes) could be useful for distinguishing a very long-term (6 years) clinical outcome of DOC patients whose EEGs were registered within 3 months post-injury. The obtained results suggest that EEG recorded at third month after sustaining brain damage, may contain useful information on the long-term outcome of patients in vegetative state: it could discriminate patients who remain in a persistent vegetative state from patients who reach a minimally conscious state or even recover a full consciousness in a long-term perspective (6 years) post-injury. These findings, if confirmed in further studies, may be pivotal for long-term planning of clinical care, rehabilitative programs, medical-legal decisions concerning the patients, and policy makers.
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Affiliation(s)
| | | | - Sergio Bagnato
- Neurorehabilitation Unit, Rehabilitation Department, Fondazione Istituto "San Raffaele - G. Giglio", Cefalù (PA), Italy; Neurophysiology Unit, Rehabilitation Department, Fondazione Istituto "San Raffaele - G. Giglio", Cefalù (PA), Italy
| | - Cristina Boccagni
- Neurorehabilitation Unit, Rehabilitation Department, Fondazione Istituto "San Raffaele - G. Giglio", Cefalù (PA), Italy; Neurophysiology Unit, Rehabilitation Department, Fondazione Istituto "San Raffaele - G. Giglio", Cefalù (PA), Italy
| | - Giuseppe Galardi
- Neurorehabilitation Unit, Rehabilitation Department, Fondazione Istituto "San Raffaele - G. Giglio", Cefalù (PA), Italy; Neurophysiology Unit, Rehabilitation Department, Fondazione Istituto "San Raffaele - G. Giglio", Cefalù (PA), Italy
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Claassen J, Rahman SA, Huang Y, Frey HP, Schmidt JM, Albers D, Falo CM, Park S, Agarwal S, Connolly ES, Kleinberg S. Causal Structure of Brain Physiology after Brain Injury from Subarachnoid Hemorrhage. PLoS One 2016; 11:e0149878. [PMID: 27123582 PMCID: PMC4849773 DOI: 10.1371/journal.pone.0149878] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/06/2016] [Indexed: 11/19/2022] Open
Abstract
High frequency physiologic data are routinely generated for intensive care patients. While massive amounts of data make it difficult for clinicians to extract meaningful signals, these data could provide insight into the state of critically ill patients and guide interventions. We develop uniquely customized computational methods to uncover the causal structure within systemic and brain physiologic measures recorded in a neurological intensive care unit after subarachnoid hemorrhage. While the data have many missing values, poor signal-to-noise ratio, and are composed from a heterogeneous patient population, our advanced imputation and causal inference techniques enable physiologic models to be learned for individuals. Our analyses confirm that complex physiologic relationships including demand and supply of oxygen underlie brain oxygen measurements and that mechanisms for brain swelling early after injury may differ from those that develop in a delayed fashion. These inference methods will enable wider use of ICU data to understand patient physiology.
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Affiliation(s)
- Jan Claassen
- Division of Critical Care Neurology, Department of Neurology, Columbia University, New York, NY, United States of America
- * E-mail:
| | - Shah Atiqur Rahman
- Computer Science Department, Stevens Institute of Technology, Hoboken, NJ, United States of America
| | - Yuxiao Huang
- Computer Science Department, Stevens Institute of Technology, Hoboken, NJ, United States of America
| | - Hans-Peter Frey
- Division of Critical Care Neurology, Department of Neurology, Columbia University, New York, NY, United States of America
| | - J. Michael Schmidt
- Division of Critical Care Neurology, Department of Neurology, Columbia University, New York, NY, United States of America
| | - David Albers
- Department of Biomedical Informatics, Columbia University, New York, NY, United States of America
| | - Cristina Maria Falo
- Division of Critical Care Neurology, Department of Neurology, Columbia University, New York, NY, United States of America
| | - Soojin Park
- Division of Critical Care Neurology, Department of Neurology, Columbia University, New York, NY, United States of America
| | - Sachin Agarwal
- Division of Critical Care Neurology, Department of Neurology, Columbia University, New York, NY, United States of America
| | - E. Sander Connolly
- Department of Neurosurgery, Columbia University, New York, NY, United States of America
| | - Samantha Kleinberg
- Computer Science Department, Stevens Institute of Technology, Hoboken, NJ, United States of America
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22
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Assessment of patients with disorder of consciousness: do different Coma Recovery Scale scoring correlate with different settings? J Neurol 2014; 261:2378-86. [DOI: 10.1007/s00415-014-7478-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/20/2014] [Accepted: 08/21/2014] [Indexed: 12/11/2022]
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23
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Bodart O, Laureys S. Predicting outcome from subacute unresponsive wakefulness syndrome or vegetative state. Crit Care 2014; 18:132. [PMID: 25029668 PMCID: PMC4056757 DOI: 10.1186/cc13831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Predicting recovery of consciousness in patients who survive their coma but evolve to a vegetative state (recently coined unresponsive wakefulness syndrome) remains a challenge. Most previous prognostic studies have focused on the acute coma phase. A novel outcome scale (combining behavioural, aetiology, electroencephalographic, sleep electroencephalographic and somatosensory evoked potential data) has been proposed for patients in subacute unresponsive wakefulness syndrome. The scale's clinical application awaits validation in a larger population.
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