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Sonneville R, Benghanem S, Jeantin L, de Montmollin E, Doman M, Gaudemer A, Thy M, Timsit JF. The spectrum of sepsis-associated encephalopathy: a clinical perspective. Crit Care 2023; 27:386. [PMID: 37798769 PMCID: PMC10552444 DOI: 10.1186/s13054-023-04655-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
Sepsis-associated encephalopathy is a severe neurologic syndrome characterized by a diffuse dysfunction of the brain caused by sepsis. This review provides a concise overview of diagnostic tools and management strategies for SAE at the acute phase and in the long term. Early recognition and diagnosis of SAE are crucial for effective management. Because neurologic evaluation can be confounded by several factors in the intensive care unit setting, a multimodal approach is warranted for diagnosis and management. Diagnostic tools commonly employed include clinical evaluation, metabolic tests, electroencephalography, and neuroimaging in selected cases. The usefulness of blood biomarkers of brain injury for diagnosis remains limited. Clinical evaluation involves assessing the patient's mental status, motor responses, brainstem reflexes, and presence of abnormal movements. Electroencephalography can rule out non-convulsive seizures and help detect several patterns of various severity such as generalized slowing, epileptiform discharges, and triphasic waves. In patients with acute encephalopathy, the diagnostic value of non-contrast computed tomography is limited. In septic patients with persistent encephalopathy, seizures, and/or focal signs, magnetic resonance imaging detects brain injury in more than 50% of cases, mainly cerebrovascular complications, and white matter changes. Timely identification and treatment of the underlying infection are paramount, along with effective control of systemic factors that may contribute to secondary brain injury. Upon admission to the ICU, maintaining appropriate levels of oxygenation, blood pressure, and metabolic balance is crucial. Throughout the ICU stay, it is important to be mindful of the potential neurotoxic effects associated with specific medications like midazolam and cefepime, and to closely monitor patients for non-convulsive seizures. The potential efficacy of targeted neurocritical care during the acute phase in optimizing patient outcomes deserves to be further investigated. Sepsis-associated encephalopathy may lead to permanent neurologic sequelae. Seizures occurring in the acute phase increase the susceptibility to long-term epilepsy. Extended ICU stays and the presence of sepsis-associated encephalopathy are linked to functional disability and neuropsychological sequelae, underscoring the necessity for long-term surveillance in the comprehensive care of septic patients.
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Affiliation(s)
- Romain Sonneville
- INSERM UMR 1137, Université Paris Cité, 75018, Paris, France.
- Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, APHP, 46 Rue Henri Huchard, 75877, Paris Cedex, France.
| | - Sarah Benghanem
- Department of Intensive Care Medicine, Cochin University Hospital, APHP, 75014, Paris, France
| | - Lina Jeantin
- Department of Neurology, Rothschild Foundation, Paris, France
| | - Etienne de Montmollin
- INSERM UMR 1137, Université Paris Cité, 75018, Paris, France
- Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, APHP, 46 Rue Henri Huchard, 75877, Paris Cedex, France
| | - Marc Doman
- Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, APHP, 46 Rue Henri Huchard, 75877, Paris Cedex, France
| | - Augustin Gaudemer
- INSERM UMR 1137, Université Paris Cité, 75018, Paris, France
- Department Radiology, Bichat-Claude Bernard University Hospital, APHP, 75018, Paris, France
| | - Michael Thy
- Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, APHP, 46 Rue Henri Huchard, 75877, Paris Cedex, France
| | - Jean-François Timsit
- INSERM UMR 1137, Université Paris Cité, 75018, Paris, France
- Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, APHP, 46 Rue Henri Huchard, 75877, Paris Cedex, France
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Floyrac A, Doumergue A, Legriel S, Deye N, Megarbane B, Richard A, Meppiel E, Masmoudi S, Lozeron P, Vicaut E, Kubis N, Holcman D. Predicting neurological outcome after cardiac arrest by combining computational parameters extracted from standard and deviant responses from auditory evoked potentials. Front Neurosci 2023; 17:988394. [PMID: 36875664 PMCID: PMC9975713 DOI: 10.3389/fnins.2023.988394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
Background Despite multimodal assessment (clinical examination, biology, brain MRI, electroencephalography, somatosensory evoked potentials, mismatch negativity at auditory evoked potentials), coma prognostic evaluation remains challenging. Methods We present here a method to predict the return to consciousness and good neurological outcome based on classification of auditory evoked potentials obtained during an oddball paradigm. Data from event-related potentials (ERPs) were recorded noninvasively using four surface electroencephalography (EEG) electrodes in a cohort of 29 post-cardiac arrest comatose patients (between day 3 and day 6 following admission). We extracted retrospectively several EEG features (standard deviation and similarity for standard auditory stimulations and number of extrema and oscillations for deviant auditory stimulations) from the time responses in a window of few hundreds of milliseconds. The responses to the standard and the deviant auditory stimulations were thus considered independently. By combining these features, based on machine learning, we built a two-dimensional map to evaluate possible group clustering. Results Analysis in two-dimensions of the present data revealed two separated clusters of patients with good versus bad neurological outcome. When favoring the highest specificity of our mathematical algorithms (0.91), we found a sensitivity of 0.83 and an accuracy of 0.90, maintained when calculation was performed using data from only one central electrode. Using Gaussian, K-neighborhood and SVM classifiers, we could predict the neurological outcome of post-anoxic comatose patients, the validity of the method being tested by a cross-validation procedure. Moreover, the same results were obtained with one single electrode (Cz). Conclusion statistics of standard and deviant responses considered separately provide complementary and confirmatory predictions of the outcome of anoxic comatose patients, better assessed when combining these features on a two-dimensional statistical map. The benefit of this method compared to classical EEG and ERP predictors should be tested in a large prospective cohort. If validated, this method could provide an alternative tool to intensivists, to better evaluate neurological outcome and improve patient management, without neurophysiologist assistance.
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Affiliation(s)
- Aymeric Floyrac
- Applied Mathematics and Computational Biology, Ecole Normale Supérieure-PSL, Paris, France
| | - Adrien Doumergue
- Applied Mathematics and Computational Biology, Ecole Normale Supérieure-PSL, Paris, France
| | - Stéphane Legriel
- Medical-Surgical Intensive Care Department, Centre Hospitalier de Versailles, Le Chesnay, France.,CESP, PsyDev Team, INSERM, UVSQ, University of Paris-Saclay, Villejuif, France
| | - Nicolas Deye
- Department of Medical and Toxicological Critical Care, APHP, Lariboisière Hospital, Paris, France.,INSERM U942, Paris, France
| | - Bruno Megarbane
- Department of Medical and Toxicological Critical Care, APHP, Lariboisière Hospital, Paris, France.,INSERM UMRS 1144, Université Paris Cité, Paris, France
| | - Alexandra Richard
- Service de Physiologie Clinique-Explorations Fonctionnelles, APHP, Hôpital Lariboisière, Paris, France
| | - Elodie Meppiel
- Service de Physiologie Clinique-Explorations Fonctionnelles, APHP, Hôpital Lariboisière, Paris, France
| | - Sana Masmoudi
- Service de Physiologie Clinique-Explorations Fonctionnelles, APHP, Hôpital Lariboisière, Paris, France
| | - Pierre Lozeron
- Service de Physiologie Clinique-Explorations Fonctionnelles, APHP, Hôpital Lariboisière, Paris, France.,LVTS UMRS 1148, Hemostasis, Thrombo-Inflammation and Neuro-Vascular Repair, CHU Xavier Bichat Secteur Claude Bernard, Université Paris Cité, Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique Saint-Louis- Lariboisière, APHP, Hôpital Saint Louis, Paris, France
| | - Nathalie Kubis
- Service de Physiologie Clinique-Explorations Fonctionnelles, APHP, Hôpital Lariboisière, Paris, France.,LVTS UMRS 1148, Hemostasis, Thrombo-Inflammation and Neuro-Vascular Repair, CHU Xavier Bichat Secteur Claude Bernard, Université Paris Cité, Paris, France
| | - David Holcman
- Applied Mathematics and Computational Biology, Ecole Normale Supérieure-PSL, Paris, France
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Witon A, Shirazibehehsti A, Cooke J, Aviles A, Adapa R, Menon DK, Chennu S, Bekinschtein T, Lopez JD, Litvak V, Li L, Friston K, Bowman H. Sedation Modulates Frontotemporal Predictive Coding Circuits and the Double Surprise Acceleration Effect. Cereb Cortex 2020; 30:5204-5217. [PMID: 32427284 PMCID: PMC7472187 DOI: 10.1093/cercor/bhaa071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/22/2020] [Accepted: 02/20/2020] [Indexed: 12/14/2022] Open
Abstract
Two important theories in cognitive neuroscience are predictive coding (PC) and the global workspace (GW) theory. A key research task is to understand how these two theories relate to one another, and particularly, how the brain transitions from a predictive early state to the eventual engagement of a brain-scale state (the GW). To address this question, we present a source-localization of EEG responses evoked by the local-global task—an experimental paradigm that engages a predictive hierarchy, which encompasses the GW. The results of our source reconstruction suggest three phases of processing. The first phase involves the sensory (here auditory) regions of the superior temporal lobe and predicts sensory regularities over a short timeframe (as per the local effect). The third phase is brain-scale, involving inferior frontal, as well as inferior and superior parietal regions, consistent with a global neuronal workspace (GNW; as per the global effect). Crucially, our analysis suggests that there is an intermediate (second) phase, involving modulatory interactions between inferior frontal and superior temporal regions. Furthermore, sedation with propofol reduces modulatory interactions in the second phase. This selective effect is consistent with a PC explanation of sedation, with propofol acting on descending predictions of the precision of prediction errors; thereby constraining access to the GNW.
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Affiliation(s)
- Adrien Witon
- School of Computing, University of Kent, Kent CT2 7NF, UK.,Center for Neuroprosthetics, EPFL, Sion 1951, Switzerland
| | - Amirali Shirazibehehsti
- School of Computing, University of Kent, Kent CT2 7NF, UK.,East Kent Hospitals University NHS Foundation Trust, Kent & Canterbury Hospital, Canterbury CT1 3NG, UK
| | - Jennifer Cooke
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Alberto Aviles
- School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
| | - Ram Adapa
- Division of Anaesthesia, Box 97, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0QQ, UK
| | - David K Menon
- Division of Anaesthesia, Box 97, Cambridge Biomedical Campus, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Srivas Chennu
- School of Computing, University of Kent, Kent CT2 7NF, UK
| | | | - Jose David Lopez
- Electronic Engineering program, Universidad de Antioquia, Ciudad Universitaria, Medellín 1226, Colombia.,Wellcome Centre for Neuroimaging, University College London, London WC1N 3AR, UK
| | - Vladimir Litvak
- Wellcome Centre for Neuroimaging, University College London, London WC1N 3AR, UK
| | - Ling Li
- School of Computing, University of Kent, Kent CT2 7NF, UK
| | - Karl Friston
- Wellcome Centre for Neuroimaging, University College London, London WC1N 3AR, UK
| | - Howard Bowman
- School of Computing, University of Kent, Kent CT2 7NF, UK.,School of Psychology, University of Birmingham, Birmingham B15 2TT, UK
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4
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Azabou E, Rohaut B, Porcher R, Heming N, Kandelman S, Allary J, Moneger G, Faugeras F, Sitt JD, Annane D, Lofaso F, Chrétien F, Mantz J, Naccache L, Sharshar T. Mismatch negativity to predict subsequent awakening in deeply sedated critically ill patients. Br J Anaesth 2018; 121:1290-1297. [PMID: 30442256 DOI: 10.1016/j.bja.2018.06.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/14/2018] [Accepted: 06/27/2018] [Indexed: 01/11/2023] Open
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.
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Affiliation(s)
- E Azabou
- 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
| | - B Rohaut
- Department of Neurology, Neuro-ICU, Columbia University, New York, NY, USA
| | - R Porcher
- Center for Clinical Epidemiology, Assistance Publique-Hôpitaux de Paris, Hotel Dieu Hospital, University Paris Descartes, INSERM U1153, Paris, France
| | - N Heming
- General Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - S Kandelman
- Department of Anesthesiology and Intensive Care Medicine, Beaujon Hospital, University of Denis Diderot, Clichy, France
| | - J Allary
- Department of Anesthesiology and Intensive Care Medicine, Beaujon Hospital, University of Denis Diderot, Clichy, France
| | - G Moneger
- General Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - F Faugeras
- Institut du Cerveau et de la Moelle épinière, Paris, France
| | - J D Sitt
- Institut du Cerveau et de la Moelle épinière, Paris, France
| | - D Annane
- General Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U1173, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - F Lofaso
- Department of Physiology, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, INSERM U 1179, University of Versailles Saint-Quentin en Yvelines, Garches, Paris, France
| | - F Chrétien
- Laboratory of Experimental Neuropathology, Institut Pasteur, Paris, France
| | - J Mantz
- Laboratory of Experimental Neuropathology, Institut Pasteur, Paris, France; Department of Anesthesiology and Intensive Care Medicine, European Hospital Georges Pompidou, Paris Descartes University, Paris, France
| | - L Naccache
- Institut du Cerveau et de la Moelle épinière, Paris, France
| | - T Sharshar
- 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.
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5
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Shirazibeheshti A, Cooke J, Chennu S, Adapa R, Menon DK, Hojjatoleslami SA, Witon A, Li L, Bekinschtein T, Bowman H. Placing meta-stable states of consciousness within the predictive coding hierarchy: The deceleration of the accelerated prediction error. Conscious Cogn 2018; 63:123-142. [DOI: 10.1016/j.concog.2018.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/28/2018] [Accepted: 06/07/2018] [Indexed: 01/19/2023]
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6
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Frølich L, Andersen TS, Mørup M. Classification of independent components of EEG into multiple artifact classes. Psychophysiology 2014; 52:32-45. [PMID: 25048104 DOI: 10.1111/psyp.12290] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 05/24/2014] [Indexed: 11/30/2022]
Abstract
In this study, we aim to automatically identify multiple artifact types in EEG. We used multinomial regression to classify independent components of EEG data, selecting from 65 spatial, spectral, and temporal features of independent components using forward selection. The classifier identified neural and five nonneural types of components. Between subjects within studies, high classification performances were obtained. Between studies, however, classification was more difficult. For neural versus nonneural classifications, performance was on par with previous results obtained by others. We found that automatic separation of multiple artifact classes is possible with a small feature set. Our method can reduce manual workload and allow for the selective removal of artifact classes. Identifying artifacts during EEG recording may be used to instruct subjects to refrain from activity causing them.
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Affiliation(s)
- Laura Frølich
- Section for Cognitive Systems, DTU Compute, Technical University of Denmark, Lyngby, Denmark
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7
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Hamil NE, Cock HR, Walker MC. Acute down-regulation of adenosine A1 receptor activity in status epilepticus. Epilepsia 2011; 53:177-88. [DOI: 10.1111/j.1528-1167.2011.03340.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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8
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Abstract
Sedative and analgesic treatment administered to critically ill patients need to be regularly assessed to ensure that predefinite goals are well achieved as the risk of complications of oversedation is minimized. In most of the cases, which are lightly sedation patients, the goal to reach is a calm, cooperative and painless patient, adapted to the ventilator. Recently, eight new bedside scoring systems to monitor sedation have been developed and mainly tested for reliability and validity. The choice of a sedation scale measuring level of consciousness, could be made between the Ramsay sedation scale, the Richmond Agitation Sedation scale (RASS) and the Adaptation to The Intensive Care Environment scale-ATICE. The Behavioral Pain Scale (BPS) is a behavioral pain scale. Two of them have been tested with strong evidence of their clinimetric properties: ATICE, RASS. The nurses'preference for a convenient tool could be defined by the level of reliability, the level of clarity, the variety of sedation and agitation states represented user friendliness and speed. In fine, the choice between a simple scale easy to use and a well-defined and complex scale has to be discussed and determined in each unit. Actually, randomized controlled studies are needed to assess the potential superiority of one scale compared with others scales, including evaluation of the reliability and the compliance to the scale. The usefulness of the BIS in ICU for patients lightly sedated is limited, mainly because of EMG artefact, when subjective scales are more appropriated in this situation. On the other hand, subjective scales are insensitive to detect oversedation in patients requiring deep sedation. The contribution of the BIS in deeply sedation patients, patients under neuromuscular blockade or barbiturates has to be proved. Pharmacoeconomics studies are lacking.
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Affiliation(s)
- M Thuong
- Service de réanimation médicale, centre hospitalier de Saint-Denis, 2, rue du Docteur-Delafontaine, 93205 Saint-Denis, France.
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9
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Tiihonen P, Kinnunen J, Töyräs J, Mervaala E, Pääkkönen A. A portable device for intensive care brain function monitoring with event-related potentials. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2008; 89:83-92. [PMID: 18068851 DOI: 10.1016/j.cmpb.2007.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 08/23/2007] [Accepted: 10/30/2007] [Indexed: 05/25/2023]
Abstract
Monitoring level of consciousness or depth of sedation is essential in modern intensive care units and emergency rooms. Current methods are based on spontaneous EEG providing only indirect information on the reactivity of the brain. Measurement of auditory event-related potentials (ERPs) has been shown to have additional potential for evaluation of the level of consciousness. Unfortunately, compact and easy-to-use devices are not commercially available. In this study a portable battery-powered device for clinical auditory ERP measurements was designed, constructed and validated. The device consists of a five-channel data logger and a 16-bit stereo audio stimulator. The signals are digitized with a 22-bit sigma-delta analogue-to-digital converter and stored to a PC Card hard disk. Prior to the in vivo application, the device was validated with extensive technical tests. Importantly, the RMS noise amplitude of the EEG channels was found to be less than 1 mivroV and the delivered auditory stimulus intensity corresponded accurately the settings (mean difference 0.2+/-0.5 dB). In addition to technical tests the device was successfully validated in vivo. To summarize, a novel portable instrument for measurement of auditory event-related potentials in intensive care environment is introduced.
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Affiliation(s)
- Pekka Tiihonen
- Department of Clinical Neurophysiology, Kuopio University Hospital, University of Kuopio, P.O. Box 1777, FIN-70211 Kuopio, Finland.
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Brander L, Slutsky A. Year in review in Critical Care, 2003 and 2004: respirology and critical care. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2005; 9:517-22. [PMID: 16277741 PMCID: PMC1297607 DOI: 10.1186/cc3764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We summarize all original research in the field of respirology and critical care published in 2003 and 2004 in Critical Care. Articles were grouped into the following categories to facilitate a rapid overview: pathophysiology, therapeutic approaches, and outcome in acute lung injury and acute respiratory distress syndrome; hypoxic pulmonary arterial hypertension; mechanical ventilation; liberation from mechanical ventilation and tracheostomy; ventilator-associated pneumonia; multidrug-resistant infections; pleural effusion; sedation and analgesia; asthma; and techniques and monitoring.
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Affiliation(s)
- Lukas Brander
- Post-doctoral research fellow, Interdepartmental Division of Critical Care, Division of Respiratory Medicine, University of Toronto, St Michael's Hospital, Toronto, Ontario, Canada
| | - Arthur Slutsky
- Professor of Medicine, Surgery and Biomedical Engineering; Director, Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada; Vice President (Research), St Michael's Hospital, Toronto, Ontario, Canada
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11
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Pandin PC. Can electrophysiological assessments of brain function be useful to the intensive care physician in daily clinical practice? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2004; 8:437-9. [PMID: 15566613 PMCID: PMC1065086 DOI: 10.1186/cc3011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Changes in electroencephalogram parameters and auditory event-related potentials, induced by interruption to propofol sedation in intensive care patients, provide a number of electrophysiological measures that can be used to assess neurological function accurately. Studies of electroencephalogram parameters suggest that power spectral estimation, as root mean square power, is more useful and precise than spectral edge frequency 95% in evaluating the functional integrity of the brain. When such parameters are used to evaluate neurological function, in particular the N100 and mismatch negativity components, a precise assessment of a patient's readiness to awaken from a pharmacologically induced coma (such as sedation) can be obtained. In terms of ease of use, however, it is more difficult to establish whether N100 or mismatch negativity is superior.
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Affiliation(s)
- Pierre C Pandin
- Anesthesiology and Critical Care, Erasmus Hospital, Free University of Brussels, Brussels, Belgium.
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