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Albrecht JN, Jaramillo V, Huber R, Karlen W, Baumann CR, Brotschi B. Technical feasibility of using auditory phase-targeted stimulation after pediatric severe traumatic brain injury in an intensive care setting. BMC Pediatr 2022; 22:616. [PMID: 36289537 PMCID: PMC9597971 DOI: 10.1186/s12887-022-03667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/26/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Supplementary treatment options after pediatric severe traumatic brain injury (TBI) are needed to improve neurodevelopmental outcome. Evidence suggests enhancement of brain delta waves via auditory phase-targeted stimulation might support neuronal reorganization, however, this method has never been applied in analgosedated patients on the pediatric intensive care unit (PICU). Therefore, we conducted a feasibility study to investigate this approach: In a first recording phase, we examined feasibility of recording over time and in a second stimulation phase, we applied stimulation to address tolerability and efficacy. Methods Pediatric patients (> 12 months of age) with severe TBI were included between May 2019 and August 2021. An electroencephalography (EEG) device capable of automatic delta wave detection and sound delivery through headphones was used to record brain activity and for stimulation (MHSL-SleepBand version 2). Stimulation tolerability was evaluated based on report of nurses, visual inspection of EEG data and clinical signals (heart rate, intracranial pressure), and whether escalation of therapy to reduce intracranial pressure was needed. Stimulation efficacy was investigated by comparing EEG power spectra of active stimulation versus muted stimulation (unpaired t-tests). Results In total, 4 out of 32 TBI patients admitted to the PICU (12.5%) between 4 and 15 years of age were enrolled in the study. All patients were enrolled in the recording phase and the last one also to the stimulation phase. Recordings started within 5 days after insult and lasted for 1–4 days. Overall, 23–88 h of EEG data per patient were collected. In patient 4, stimulation was enabled for 50 min: No signs of patient stress reactions were observed. Power spectrums between active and muted stimulation were not statistically different (all P > .05). Conclusion Results suggests good feasibility of continuously applying devices needed for auditory stimulation over multiple days in pediatric patients with TBI on PICU. Very preliminary evidence suggests good tolerability of auditory stimuli, but efficacy of auditory stimuli to enhance delta waves remains unclear and requires further investigation. However, only low numbers of severe TBI patients could be enrolled in the study and, thus, future studies should consider an international multicentre approach.
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Affiliation(s)
- Joëlle Ninon Albrecht
- grid.7400.30000 0004 1937 0650Child Development Center, University Children’s Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Children’s Research Center, University Children’s Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland
| | - Valeria Jaramillo
- grid.7400.30000 0004 1937 0650Child Development Center, University Children’s Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Children’s Research Center, University Children’s Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland ,grid.5475.30000 0004 0407 4824Surrey Sleep Research Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK ,grid.5475.30000 0004 0407 4824Neuromodulation Laboratory, School of Psychology, University of Surrey, Guildford, UK ,grid.7445.20000 0001 2113 8111Care Research and Technology Centre, UK Dementia Research Institute, at Imperial College, University of Surrey, London, Guildford, UK
| | - Reto Huber
- grid.7400.30000 0004 1937 0650Child Development Center, University Children’s Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Children’s Research Center, University Children’s Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich (UZH), Zurich, Switzerland
| | - Walter Karlen
- grid.5801.c0000 0001 2156 2780Mobile Health Systems Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland ,grid.6582.90000 0004 1936 9748Institute of Biomedical Engineering, University of Ulm, Ulm, Germany
| | - Christian Rainer Baumann
- grid.412004.30000 0004 0478 9977Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Barbara Brotschi
- grid.7400.30000 0004 1937 0650Children’s Research Center, University Children’s Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Department of Neonatology and Paediatric Intensive Care, University Children’s Hospital Zurich, University of Zurich (UZH), Zurich, Switzerland
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