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Konar S, Shukla D, Indira Devi B, Christopher R, S N, Puybasset L, Chakrabarti D, Sundaravadivel P, Nirmal S. Role of substance P in cerebral edema and association with an estimated specific gravity of the brain and an outcome prediction in post-traumatic cerebral edema. World Neurosurg X 2024; 23:100355. [PMID: 38516024 PMCID: PMC10955688 DOI: 10.1016/j.wnsx.2024.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
Purpose The study aims to evaluate the role of substance P in cerebral edema and outcomes associated with acute TBI. Method Patients with acute TBI who presented within 6 h and a CT scan showed predominantly cerebral edema were included in the study. Substance P level was assessed from a serum sample collected within 6 h of trauma. We also evaluated the brain-specific gravity using the Brain View software. Result A total of 160 (128 male) patients were recruited. The median serum substance P concentration was 167.89 (IQR: 101.09-238.2). Substance P concentration was high in the early hours after trauma (p = 0.001). The median specific gravity of the entire brain was 1.04. Patients with a low Glasgow coma scale (GCS) at admission had a high concentration of the substance P. In the univariate analysis, low GCS, elevated serum concentrations of substance P level, high Rotterdam grade, high cerebral edema grade, a high international normalized ratio value, and high blood sugar levels were associated with poor outcomes at six months. In logistic regression analysis, low GCS at admission, high cerebral edema grade, and elevated blood sugar level were strongly associated with poor outcomes at six months. The area under the receiver operating characteristic curve was 0.884 (0.826-0.941). Conclusion Serum substance P is strongly associated with the severity of cerebral edema after TBI. However, brain-specific gravity does not directly correlate with posttraumatic cerebral edema severity. Serum substance P does not influence the clinical outcome of traumatic brain injury.
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Affiliation(s)
- Subhas Konar
- Dept. of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Dhaval Shukla
- Dept. of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - B. Indira Devi
- Dept. of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Rita Christopher
- Lab Director, Integrative Medical Research, PES University Institute of Medical Sciences and Research (PESUIMSR), Bengaluru 560100, India
| | - Nishanth S
- Dept. of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Louis Puybasset
- Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Laboratoire D'imagerie Biomédicale LIB,Paris, France
| | | | - P. Sundaravadivel
- Dept. of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Shubham Nirmal
- Dept. of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Sicard M, Shor N, Davy V, Rouby JJ, Oquendo B, Maisonobe T, Puybasset L, Lehericy S, Lecarpentier A, Donadio C, Oasi C, Belmin J, Lubetzki C, Corvol JC, Grabli D, Saracino D. Cerebellar encephalitis and peripheral neuropathy with an atypical clinical and neuroimaging signature following Covid-19 vaccine: a report of two cases. J Neurol 2024:10.1007/s00415-024-12390-5. [PMID: 38704487 DOI: 10.1007/s00415-024-12390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/11/2024] [Accepted: 04/14/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Marin Sicard
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Natalia Shor
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neuroradiology, Paris, France
| | - Vincent Davy
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Jean-Jacques Rouby
- Sorbonne Université, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Department of Anesthesiology and Critical Care, Paris, France
| | - Bruno Oquendo
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Thierry Maisonobe
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - Louis Puybasset
- Sorbonne Université, GRC 29, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpital Pitié-Salpêtrière, Department of Anesthesiology and Critical Care, Paris, France
| | - Stephane Lehericy
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neuroradiology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Amandine Lecarpentier
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Cristiano Donadio
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Christel Oasi
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Joël Belmin
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Charles-Foix, Service de Gériatrie à Orientation Cardiologique et Neurologique, Ivry-sur-Seine, France
| | - Catherine Lubetzki
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - David Grabli
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
| | - Dario Saracino
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France.
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris Brain Institute - ICM, Inserm, CNRS, Paris, France.
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Departement of Neurology, Reference Centre for Rare or Early Dementias, Paris, France.
- Paris Brain Institute - Institut du Cerveau (ICM), AP-HP - Hôpital Pitié-Salpêtrière, DMU Neurosciences, Département de Neurologie, 47-83 boulevard de l'Hôpital, 75013, Paris, France.
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3
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Jacquens A, Delmotte PR, Gourbeix C, Farny N, Perret-Liaudet B, Hijazi D, Batisti V, Torkomian G, Cassereau D, Debarle C, Shotar E, Gellman C, Mathon B, Bayen E, Galanaud D, Perlbarg V, Puybasset L, Degos V. MRI volumetry and diffusion tensor imaging for diagnosis and follow-up of late post-traumatic injuries. Ann Phys Rehabil Med 2024; 67:101783. [PMID: 38147704 DOI: 10.1016/j.rehab.2023.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 05/02/2023] [Accepted: 05/29/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Traumatic Brain Injury (TBI) is a major cause of acquired disability and can cause devastating and progressive post-traumatic encephalopathy. TBI is a dynamic condition that continues to evolve over time. A better understanding of the pathophysiology of these late lesions is important for the development of new therapeutic strategies. OBJECTIVES The primary objective was to compare the ability of fluid-attenuated reversion recovery (FLAIR) and diffusion tensor imaging (DTI) magnetic resonance imaging (MRI) markers to identify participants with a Glasgow outcome scale extended (GOS-E) score of 7-8, up to 10 years after their original TBI. The secondary objective was to study the brain regionalization of DTI markers. Finally, we analyzed the evolution of late-developing brain lesions using repeated MRI images, also taken up to 10 years after the TBI. METHODS In this retrospective study, participants were included from a cohort of people hospitalized following a severe TBI. Following their discharge, they were followed-up and clinically assessed, including a DTI-MRI scan, between 2012 and 2016. We performed a cross-sectional analysis on 97 participants at a median (IQR) of 5 years (3-6) post-TBI, and a further post-TBI longitudinal analysis over 10 years on a subpopulation (n = 17) of the cohort. RESULTS Although the area under the curve (AUC) of FLAIR, fractional anisotropy (FA), and mean diffusivity (MD) were not significantly different, only the AUC of FA was statistically greater than 0.5. In addition, only the FA was correlated with clinical outcomes as assessed by GOS-E score (P<10-4). On the cross-sectional analysis, DTI markers allowed study post-TBI white matter lesions by region. In the longitudinal subpopulation analysis, the observed number of brain lesions increased for the first 5 years post-TBI, before stabilizing over the next 5 years. CONCLUSIONS This study has shown for the first time that post-TBI lesions can present in a two-phase evolution. These results must be confirmed in larger studies. French Data Protection Agency (Commission nationale de l'informatique et des libertés; CNIL) study registration no: 1934708v0.
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Affiliation(s)
- Alice Jacquens
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France.
| | - Pierre-Romain Delmotte
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Claire Gourbeix
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Nicolas Farny
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Bérenger Perret-Liaudet
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Dany Hijazi
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Valentine Batisti
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Grégory Torkomian
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Didier Cassereau
- Laboratoire d'Imagerie Biomédicale, Sorbonne Université, 15 rue de l'Ecole de Médecine, 75006, Paris, France; ESPCI, 10 rue Vauquelin, 75005, Paris, France
| | - Clara Debarle
- Physical Medicine and Rehabilitation Department, Centre Hospitalier Saint-Anne, 1 rue Cabanis, GHU Paris psychiatrie et neurosciences, 75014, Paris, France
| | - Eimad Shotar
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Celia Gellman
- Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Elmhurst, Internal Medicine Residency Program, United States
| | - Bertrand Mathon
- Department of Neurosurgery, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, 47-83, Boulevard de L'Hôpital, 75651 Cedex 13, Paris, France
| | - Eleonor Bayen
- UGECAM-IdF, groupe hospitalier Pitié-Salpêtrière, service de médecine physique et de réadaptation, Paris France
| | - Damien Galanaud
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de Neuroradiologie, 75013, Paris, France
| | | | - Louis Puybasset
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France; BRAINTALE SAS, Paris, France
| | - Vincent Degos
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
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4
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Edlow BL, Boerwinkle VL, Annen J, Boly M, Gosseries O, Laureys S, Mukherjee P, Puybasset L, Stevens RD, Threlkeld ZD, Newcombe VFJ, Fernandez-Espejo D. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Neuroimaging. Neurocrit Care 2023; 39:611-617. [PMID: 37552410 DOI: 10.1007/s12028-023-01794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Over the past 5 decades, advances in neuroimaging have yielded insights into the pathophysiologic mechanisms that cause disorders of consciousness (DoC) in patients with severe brain injuries. Structural, functional, metabolic, and perfusion imaging studies have revealed specific neuroanatomic regions, such as the brainstem tegmentum, thalamus, posterior cingulate cortex, medial prefrontal cortex, and occipital cortex, where lesions correlate with the current or future state of consciousness. Advanced imaging modalities, such as diffusion tensor imaging, resting-state functional magnetic resonance imaging (fMRI), and task-based fMRI, have been used to improve the accuracy of diagnosis and long-term prognosis, culminating in the endorsement of fMRI for the clinical evaluation of patients with DoC in the 2018 US (task-based fMRI) and 2020 European (task-based and resting-state fMRI) guidelines. As diverse neuroimaging techniques are increasingly used for patients with DoC in research and clinical settings, the need for a standardized approach to reporting results is clear. The success of future multicenter collaborations and international trials fundamentally depends on the implementation of a shared nomenclature and infrastructure. METHODS To address this need, the Neurocritical Care Society's Curing Coma Campaign convened an international panel of DoC neuroimaging experts to propose common data elements (CDEs) for data collection and reporting in this field. RESULTS We report the recommendations of this CDE development panel and disseminate CDEs to be used in neuroimaging studies of patients with DoC. CONCLUSIONS These CDEs will support progress in the field of DoC neuroimaging and facilitate international collaboration.
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Affiliation(s)
- Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
| | - Varina L Boerwinkle
- Clinical Resting-State Functional Magnetic Resonance Imaging Laboratory and Service, Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jitka Annen
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre de Cerveau2, University Hospital of Liège, Liège, Belgium
| | - Melanie Boly
- Department of Neurology, University of Wisconsin, Madison, WI, USA
- Department of Psychiatry, Wisconsin Institute for Sleep and Consciousness, University of Wisconsin, Madison, WI, USA
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre de Cerveau2, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre de Cerveau2, University Hospital of Liège, Liège, Belgium
- CERVO Research Institute, Laval University, Quebec, Canada
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Louis Puybasset
- Department of Anesthesiology and Intensive Care, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Robert D Stevens
- Departments of Anesthesiology and Critical Care Medicine, Neurology, Radiology, and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zachary D Threlkeld
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Davinia Fernandez-Espejo
- School of Psychology and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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5
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Edlow BL, Boerwinkle VL, Annen J, Boly M, Gosseries O, Laureys S, Mukherjee P, Puybasset L, Stevens RD, Threlkeld ZD, Newcombe VFJ, Fernandez-Espejo D. Correction: Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Neuroimaging. Neurocrit Care 2023; 39:753. [PMID: 37794309 DOI: 10.1007/s12028-023-01842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Affiliation(s)
- Brian L Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.
| | - Varina L Boerwinkle
- Clinical Resting-State Functional Magnetic Resonance Imaging Laboratory and Service, Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jitka Annen
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre de Cerveau2, University Hospital of Liège, Liège, Belgium
| | - Melanie Boly
- Department of Neurology, University of Wisconsin, Madison, WI, USA
- Department of Psychiatry, Wisconsin Institute for Sleep and Consciousness, University of Wisconsin, Madison, WI, USA
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre de Cerveau2, University Hospital of Liège, Liège, Belgium
| | - Steven Laureys
- Coma Science Group, GIGA Consciousness, University of Liège, Liège, Belgium
- Centre de Cerveau2, University Hospital of Liège, Liège, Belgium
- CERVO Research Institute, Laval University, Quebec, Canada
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Louis Puybasset
- Department of Anesthesiology and Intensive Care, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Robert D Stevens
- Departments of Anesthesiology and Critical Care Medicine, Neurology, Radiology, and Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zachary D Threlkeld
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Davinia Fernandez-Espejo
- School of Psychology and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
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6
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Menat S, Jacquens A, Mathon B, Bonnet B, Schotar E, Boch AL, Carpentier A, Puybasset L, Abdennour L, Degos V. Corticosteroid treatment for refractory intracranial hypertension: a rescue therapy in patients with severe traumatic brain injury with contusional lesions-a feedback. Acta Neurochir (Wien) 2023; 165:717-725. [PMID: 36808006 DOI: 10.1007/s00701-023-05507-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/21/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Refractory intracranial hypertension (rICH) is a severe complication among patients with severe traumatic brain injury (sTBI). Medical treatment may be insufficient, and in some cases, the only viable treatment option is decompressive hemicraniectomy. The assessment of a corticosteroid therapy against vasogenic edema secondary to severe brain injuries seems interesting to prevent this surgery in sTBI patients with rICH caused by contusional areas. METHODS This is a monocentric retrospective observational study including all consecutive sTBI patients with contusion injuries and a rICH requiring cerebrospinal fluid drainage with external ventricular drainage between November 2013 and January 2018. Patient inclusion criterium was a therapeutic index load (TIL; an indirect measure of TBI severity) > 7. Intracranial pressure (ICP) and TIL were assessed before and 48 h after corticosteroid therapy (CTC). Then, we divided the population into two groups according to the evolution of the TIL: responders and non-responders to corticosteroid therapy. RESULTS During the study period, 512 patients were hospitalized for sTBI, and among them, 44 (8.6%) with rICH were included. They received 240 mg per day [120 mg, 240 mg] of Solu-Medrol for 2 days [1; 3], 3 days after the sTBI. The average ICP in patients with rICH before the CTC bolus was 21 mmHg [19; 23]. After the CTC bolus, the ICP fell significantly to less than 15 mmHg (p < 0.0001) for at least 7 days. The TIL decreased significantly the day after the CTC bolus and until day 2. Among these 44 patients, 68% were included in the responder group (n = 30). DISCUSSION Short and systemic corticosteroid therapy in patients with refractory intracranial hypertension secondary to severe traumatic brain injury seems to be a potentially useful and efficient treatment for lowering intracranial pressure and decreasing the need for more invasive surgeries.
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Affiliation(s)
- Sophie Menat
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Alice Jacquens
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France.
| | - Bertrand Mathon
- Department of Neurosurgery, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Baptiste Bonnet
- Department of Neuroradiology, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Eimad Schotar
- Department of Neuroradiology, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Anne-Laure Boch
- Department of Neurosurgery, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France.,Department of Neuroradiology, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Alexandre Carpentier
- Department of Neurosurgery, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Louis Puybasset
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France.,Department of Neuroradiology, APHP - Sorbonne University, La Pitié-Salpêtrière Hospital, Paris, France
| | - Lamine Abdennour
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
| | - Vincent Degos
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013, Paris, France
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7
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Puybasset L, Perlbarg V, Unrug J, Cassereau D, Galanaud D, Torkomian G, Battisti V, Lefort M, Velly L, Degos V, Citerio G, Bayen É, Pelegrini-Issac M. Prognostic value of global deep white matter DTI metrics for 1-year outcome prediction in ICU traumatic brain injury patients: an MRI-COMA and CENTER-TBI combined study. Intensive Care Med 2022; 48:201-212. [PMID: 34904191 DOI: 10.1007/s00134-021-06583-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/11/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE A reliable tool for outcome prognostication in severe traumatic brain injury (TBI) would improve intensive care unit (ICU) decision-making process by providing objective information to caregivers and family. This study aimed at designing a new classification score based on magnetic resonance (MR) diffusion metrics measured in the deep white matter between day 7 and day 35 after TBI to predict 1-year clinical outcome. METHODS Two multicenter cohorts (29 centers) were used. MRI-COMA cohort (NCT00577954) was split into MRI-COMA-Train (50 patients enrolled between 2006 and mid-2014) and MRI-COMA-Test (140 patients followed up in clinical routine from 2014) sub-cohorts. These latter patients were pooled with 56 ICU patients (enrolled from 2014 to 2020) from CENTER-TBI cohort (NCT02210221). Patients were dichotomised depending on their 1-year Glasgow outcome scale extended (GOSE) score: GOSE 1-3, unfavorable outcome (UFO); GOSE 4-8, favorable outcome (FO). A support vector classifier incorporating fractional anisotropy and mean diffusivity measured in deep white matter, and age at the time of injury was developed to predict whether the patients would be either UFO or FO. RESULTS The model achieved an area under the ROC curve of 0.93 on MRI-COMA-Train training dataset, and 49% sensitivity for 96.8% specificity in predicting UFO and 58.5% sensitivity for 97.1% specificity in predicting FO on the pooled MRI-COMA-Test and CENTER-TBI validation datasets. CONCLUSION The model successfully identified, with a specificity compatible with a personalized decision-making process in ICU, one in two patients who had an unfavorable outcome at 1 year after the injury, and two-thirds of the patients who experienced a favorable outcome.
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Affiliation(s)
- Louis Puybasset
- Neurosurgical Intensive Care Unit, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France.
- Department of Anesthesiology and Intensive Care, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
- Clinical Research Group 29, Sorbonne Université, Paris, France.
| | | | - Jean Unrug
- Neurosurgical Intensive Care Unit, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France
| | - Didier Cassereau
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France
| | - Damien Galanaud
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France
- Department of Neuroradiology, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Grégory Torkomian
- Neurosurgical Intensive Care Unit, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Valentine Battisti
- Neurosurgical Intensive Care Unit, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Muriel Lefort
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France
| | - Lionel Velly
- Department of Anesthesiology and Critical Care Medicine, University Hospital Timone, AP-HM, Aix Marseille University, Marseille, France
- CNRS, Institute of Neuroscience Timone, UMR7289, Aix Marseille University, Marseille, France
| | - Vincent Degos
- Clinical Research Group 29, Sorbonne Université, Paris, France
- Department of Anesthesia, Critical Care and Peri-Operative Medicine, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM UMR 1141, Paris, France
| | - Guiseppe Citerio
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Neurointensive Care Unit, Department of Emergency and Urgency, ASST-Monza, San Gerardo Hospital, Monza, Italy
| | - Éléonore Bayen
- Laboratoire d'Imagerie Biomédicale (LIB), Sorbonne Université, CNRS, INSERM, Paris, France
- Rehabilitation Unit, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
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Maas AIR, Menon DK, Manley GT, Abrams M, Åkerlund C, Andelic N, Aries M, Bashford T, Bell MJ, Bodien YG, Brett BL, Büki A, Chesnut RM, Citerio G, Clark D, Clasby B, Cooper DJ, Czeiter E, Czosnyka M, Dams-O’Connor K, De Keyser V, Diaz-Arrastia R, Ercole A, van Essen TA, Falvey É, Ferguson AR, Figaji A, Fitzgerald M, Foreman B, Gantner D, Gao G, Giacino J, Gravesteijn B, Guiza F, Gupta D, Gurnell M, Haagsma JA, Hammond FM, Hawryluk G, Hutchinson P, van der Jagt M, Jain S, Jain S, Jiang JY, Kent H, Kolias A, Kompanje EJO, Lecky F, Lingsma HF, Maegele M, Majdan M, Markowitz A, McCrea M, Meyfroidt G, Mikolić A, Mondello S, Mukherjee P, Nelson D, Nelson LD, Newcombe V, Okonkwo D, Orešič M, Peul W, Pisică D, Polinder S, Ponsford J, Puybasset L, Raj R, Robba C, Røe C, Rosand J, Schueler P, Sharp DJ, Smielewski P, Stein MB, von Steinbüchel N, Stewart W, Steyerberg EW, Stocchetti N, Temkin N, Tenovuo O, Theadom A, Thomas I, Espin AT, Turgeon AF, Unterberg A, Van Praag D, van Veen E, Verheyden J, Vyvere TV, Wang KKW, Wiegers EJA, Williams WH, Wilson L, Wisniewski SR, Younsi A, Yue JK, Yuh EL, Zeiler FA, Zeldovich M, Zemek R. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol 2022; 21:1004-1060. [PMID: 36183712 PMCID: PMC10427240 DOI: 10.1016/s1474-4422(22)00309-x] [Citation(s) in RCA: 168] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/22/2022] [Indexed: 02/06/2023]
Abstract
Traumatic brain injury (TBI) has the highest incidence of all common neurological disorders, and poses a substantial public health burden. TBI is increasingly documented not only as an acute condition but also as a chronic disease with long-term consequences, including an increased risk of late-onset neurodegeneration. The first Lancet Neurology Commission on TBI, published in 2017, called for a concerted effort to tackle the global health problem posed by TBI. Since then, funding agencies have supported research both in high-income countries (HICs) and in low-income and middle-income countries (LMICs). In November 2020, the World Health Assembly, the decision-making body of WHO, passed resolution WHA73.10 for global actions on epilepsy and other neurological disorders, and WHO launched the Decade for Action on Road Safety plan in 2021. New knowledge has been generated by large observational studies, including those conducted under the umbrella of the International Traumatic Brain Injury Research (InTBIR) initiative, established as a collaboration of funding agencies in 2011. InTBIR has also provided a huge stimulus to collaborative research in TBI and has facilitated participation of global partners. The return on investment has been high, but many needs of patients with TBI remain unaddressed. This update to the 2017 Commission presents advances and discusses persisting and new challenges in prevention, clinical care, and research. In LMICs, the occurrence of TBI is driven by road traffic incidents, often involving vulnerable road users such as motorcyclists and pedestrians. In HICs, most TBI is caused by falls, particularly in older people (aged ≥65 years), who often have comorbidities. Risk factors such as frailty and alcohol misuse provide opportunities for targeted prevention actions. Little evidence exists to inform treatment of older patients, who have been commonly excluded from past clinical trials—consequently, appropriate evidence is urgently required. Although increasing age is associated with worse outcomes from TBI, age should not dictate limitations in therapy. However, patients injured by low-energy falls (who are mostly older people) are about 50% less likely to receive critical care or emergency interventions, compared with those injured by high-energy mechanisms, such as road traffic incidents. Mild TBI, defined as a Glasgow Coma sum score of 13–15, comprises most of the TBI cases (over 90%) presenting to hospital. Around 50% of adult patients with mild TBI presenting to hospital do not recover to pre-TBI levels of health by 6 months after their injury. Fewer than 10% of patients discharged after presenting to an emergency department for TBI in Europe currently receive follow-up. Structured follow-up after mild TBI should be considered good practice, and urgent research is needed to identify which patients with mild TBI are at risk for incomplete recovery. The selection of patients for CT is an important triage decision in mild TBI since it allows early identification of lesions that can trigger hospital admission or life-saving surgery. Current decision making for deciding on CT is inefficient, with 90–95% of scanned patients showing no intracranial injury but being subjected to radiation risks. InTBIR studies have shown that measurement of blood-based biomarkers adds value to previously proposed clinical decision rules, holding the potential to improve efficiency while reducing radiation exposure. Increased concentrations of biomarkers in the blood of patients with a normal presentation CT scan suggest structural brain damage, which is seen on MR scanning in up to 30% of patients with mild TBI. Advanced MRI, including diffusion tensor imaging and volumetric analyses, can identify additional injuries not detectable by visual inspection of standard clinical MR images. Thus, the absence of CT abnormalities does not exclude structural damage—an observation relevant to litigation procedures, to management of mild TBI, and when CT scans are insufficient to explain the severity of the clinical condition. Although blood-based protein biomarkers have been shown to have important roles in the evaluation of TBI, most available assays are for research use only. To date, there is only one vendor of such assays with regulatory clearance in Europe and the USA with an indication to rule out the need for CT imaging for patients with suspected TBI. Regulatory clearance is provided for a combination of biomarkers, although evidence is accumulating that a single biomarker can perform as well as a combination. Additional biomarkers and more clinical-use platforms are on the horizon, but cross-platform harmonisation of results is needed. Health-care efficiency would benefit from diversity in providers. In the intensive care setting, automated analysis of blood pressure and intracranial pressure with calculation of derived parameters can help individualise management of TBI. Interest in the identification of subgroups of patients who might benefit more from some specific therapeutic approaches than others represents a welcome shift towards precision medicine. Comparative-effectiveness research to identify best practice has delivered on expectations for providing evidence in support of best practices, both in adult and paediatric patients with TBI. Progress has also been made in improving outcome assessment after TBI. Key instruments have been translated into up to 20 languages and linguistically validated, and are now internationally available for clinical and research use. TBI affects multiple domains of functioning, and outcomes are affected by personal characteristics and life-course events, consistent with a multifactorial bio-psycho-socio-ecological model of TBI, as presented in the US National Academies of Sciences, Engineering, and Medicine (NASEM) 2022 report. Multidimensional assessment is desirable and might be best based on measurement of global functional impairment. More work is required to develop and implement recommendations for multidimensional assessment. Prediction of outcome is relevant to patients and their families, and can facilitate the benchmarking of quality of care. InTBIR studies have identified new building blocks (eg, blood biomarkers and quantitative CT analysis) to refine existing prognostic models. Further improvement in prognostication could come from MRI, genetics, and the integration of dynamic changes in patient status after presentation. Neurotrauma researchers traditionally seek translation of their research findings through publications, clinical guidelines, and industry collaborations. However, to effectively impact clinical care and outcome, interactions are also needed with research funders, regulators, and policy makers, and partnership with patient organisations. Such interactions are increasingly taking place, with exemplars including interactions with the All Party Parliamentary Group on Acquired Brain Injury in the UK, the production of the NASEM report in the USA, and interactions with the US Food and Drug Administration. More interactions should be encouraged, and future discussions with regulators should include debates around consent from patients with acute mental incapacity and data sharing. Data sharing is strongly advocated by funding agencies. From January 2023, the US National Institutes of Health will require upload of research data into public repositories, but the EU requires data controllers to safeguard data security and privacy regulation. The tension between open data-sharing and adherence to privacy regulation could be resolved by cross-dataset analyses on federated platforms, with the data remaining at their original safe location. Tools already exist for conventional statistical analyses on federated platforms, however federated machine learning requires further development. Support for further development of federated platforms, and neuroinformatics more generally, should be a priority. This update to the 2017 Commission presents new insights and challenges across a range of topics around TBI: epidemiology and prevention (section 1 ); system of care (section 2 ); clinical management (section 3 ); characterisation of TBI (section 4 ); outcome assessment (section 5 ); prognosis (Section 6 ); and new directions for acquiring and implementing evidence (section 7 ). Table 1 summarises key messages from this Commission and proposes recommendations for the way forward to advance research and clinical management of TBI.
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Affiliation(s)
- Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Mathew Abrams
- International Neuroinformatics Coordinating Facility, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Åkerlund
- Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Nada Andelic
- Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Marcel Aries
- Department of Intensive Care, Maastricht UMC, Maastricht, Netherlands
| | - Tom Bashford
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Michael J Bell
- Critical Care Medicine, Neurological Surgery and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yelena G Bodien
- Department of Neurology and Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - András Büki
- Department of Neurosurgery, Faculty of Medicine and Health Örebro University, Örebro, Sweden
- Department of Neurosurgery, Medical School; ELKH-PTE Clinical Neuroscience MR Research Group; and Neurotrauma Research Group, Janos Szentagothai Research Centre, University of Pecs, Pecs, Hungary
| | - Randall M Chesnut
- Department of Neurological Surgery and Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - Giuseppe Citerio
- School of Medicine and Surgery, Universita Milano Bicocca, Milan, Italy
- NeuroIntensive Care, San Gerardo Hospital, Azienda Socio Sanitaria Territoriale (ASST) Monza, Monza, Italy
| | - David Clark
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Betony Clasby
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - D Jamie Cooper
- School of Public Health and Preventive Medicine, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Endre Czeiter
- Department of Neurosurgery, Medical School; ELKH-PTE Clinical Neuroscience MR Research Group; and Neurotrauma Research Group, Janos Szentagothai Research Centre, University of Pecs, Pecs, Hungary
| | - Marek Czosnyka
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Kristen Dams-O’Connor
- Department of Rehabilitation and Human Performance and Department of Neurology, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Véronique De Keyser
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Ramon Diaz-Arrastia
- Department of Neurology and Center for Brain Injury and Repair, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Thomas A van Essen
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Neurosurgery, Medical Center Haaglanden, The Hague, Netherlands
| | - Éanna Falvey
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Adam R Ferguson
- Brain and Spinal Injury Center, Department of Neurological Surgery, Weill Institute for Neurosciences, University of California San Francisco and San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Anthony Figaji
- Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Melinda Fitzgerald
- Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
- Perron Institute for Neurological and Translational Sciences, Nedlands, WA, Australia
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati, Cincinnati, OH, USA
| | - Dashiell Gantner
- School of Public Health and Preventive Medicine, Monash University and The Alfred Hospital, Melbourne, VIC, Australia
| | - Guoyi Gao
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine
| | - Joseph Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Benjamin Gravesteijn
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Fabian Guiza
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Deepak Gupta
- Department of Neurosurgery, Neurosciences Centre and JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Mark Gurnell
- Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN, USA
| | - Gregory Hawryluk
- Section of Neurosurgery, GB1, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Peter Hutchinson
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sonia Jain
- Biostatistics Research Center, Herbert Wertheim School of Public Health, University of California, San Diego, CA, USA
| | - Swati Jain
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Ji-yao Jiang
- Department of Neurosurgery, Shanghai Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hope Kent
- Department of Psychology, University of Exeter, Exeter, UK
| | - Angelos Kolias
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Erwin J O Kompanje
- Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Hester F Lingsma
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marc Maegele
- Cologne-Merheim Medical Center, Department of Trauma and Orthopedic Surgery, Witten/Herdecke University, Cologne, Germany
| | - Marek Majdan
- Institute for Global Health and Epidemiology, Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
| | - Amy Markowitz
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Michael McCrea
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Ana Mikolić
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Pratik Mukherjee
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - David Nelson
- Section for Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Lindsay D Nelson
- Department of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Virginia Newcombe
- Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - David Okonkwo
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matej Orešič
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Wilco Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - Dana Pisică
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Neurosurgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jennie Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Louis Puybasset
- Department of Anesthesiology and Intensive Care, APHP, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Chiara Robba
- Department of Anaesthesia and Intensive Care, Policlinico San Martino IRCCS for Oncology and Neuroscience, Genova, Italy, and Dipartimento di Scienze Chirurgiche e Diagnostiche, University of Genoa, Italy
| | - Cecilie Røe
- Division of Clinical Neuroscience, Department of Physical Medicine and Rehabilitation, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Jonathan Rosand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | | | - David J Sharp
- Department of Brain Sciences, Imperial College London, London, UK
| | - Peter Smielewski
- Brain Physics Lab, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Murray B Stein
- Department of Psychiatry and Department of Family Medicine and Public Health, UCSD School of Medicine, La Jolla, CA, USA
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - William Stewart
- Department of Neuropathology, Queen Elizabeth University Hospital and University of Glasgow, Glasgow, UK
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences Leiden University Medical Center, Leiden, Netherlands
| | - Nino Stocchetti
- Department of Pathophysiology and Transplantation, Milan University, and Neuroscience ICU, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nancy Temkin
- Departments of Neurological Surgery, and Biostatistics, University of Washington, Seattle, WA, USA
| | - Olli Tenovuo
- Department of Rehabilitation and Brain Trauma, Turku University Hospital, and Department of Neurology, University of Turku, Turku, Finland
| | - Alice Theadom
- National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand
| | - Ilias Thomas
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Abel Torres Espin
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, CHU de Québec-Université Laval Research Center, Québec City, QC, Canada
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Dominique Van Praag
- Departments of Clinical Psychology and Neurosurgery, Antwerp University Hospital, and University of Antwerp, Edegem, Belgium
| | - Ernest van Veen
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Thijs Vande Vyvere
- Department of Radiology, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences (MOVANT), Antwerp University Hospital, and University of Antwerp, Edegem, Belgium
| | - Kevin K W Wang
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Eveline J A Wiegers
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - W Huw Williams
- Centre for Clinical Neuropsychology Research, Department of Psychology, University of Exeter, Exeter, UK
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Stephen R Wisniewski
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Alexander Younsi
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - John K Yue
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Esther L Yuh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Frederick A Zeiler
- Departments of Surgery, Human Anatomy and Cell Science, and Biomedical Engineering, Rady Faculty of Health Sciences and Price Faculty of Engineering, University of Manitoba, Winnipeg, MB, Canada
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Roger Zemek
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario, ON, Canada
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Mainali S, Aiyagari V, Alexander S, Bodien Y, Boerwinkle V, Boly M, Brown E, Brown J, Claassen J, Edlow BL, Fink EL, Fins JJ, Foreman B, Frontera J, Geocadin RG, Giacino J, Gilmore EJ, Gosseries O, Hammond F, Helbok R, Claude Hemphill J, Hirsch K, Kim K, Laureys S, Lewis A, Ling G, Livesay SL, McCredie V, McNett M, Menon D, Molteni E, Olson D, O'Phelan K, Park S, Polizzotto L, Javier Provencio J, Puybasset L, Venkatasubba Rao CP, Robertson C, Rohaut B, Rubin M, Sharshar T, Shutter L, Sampaio Silva G, Smith W, Stevens RD, Thibaut A, Vespa P, Wagner AK, Ziai WC, Zink E, Suarez JI. Correction to: Proceedings of the Second Curing Coma Campaign NIH Symposium: Challenging the Future of Research for Coma and Disorders of Consciousness. Neurocrit Care 2022; 37:608-609. [PMID: 35715614 PMCID: PMC9519697 DOI: 10.1007/s12028-022-01536-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | - Venkatesh Aiyagari
- Neurological Surgery and Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sheila Alexander
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yelena Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Varina Boerwinkle
- Division of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Melanie Boly
- Departments of Neurology and Psychiatry, Wisconsin Institute for Sleep and Consciousness, University of Wisconsin, Madison, WI, USA
| | - Emery Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeremy Brown
- Office of Emergency Care Research, Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Jan Claassen
- Department of Neurology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Brian L Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Ericka L Fink
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joseph J Fins
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY, USA
- Yale Law School, New Haven, CT, USA
| | - Brandon Foreman
- Division of Neurocritical Care, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer Frontera
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Romergryko G Geocadin
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph Giacino
- Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Emily J Gilmore
- Comprehensive Epilepsy Center, Department of Neurology, Yale University, New Haven, CT, USA
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Flora Hammond
- Indiana University Department of Physical Medicine and Rehabilitation, University of Indiana School of Medicine, Indianapolis, IN, USA
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Claude Hemphill
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Karen Hirsch
- Division of Neurocritical Care, Department of Neurology, Stanford University, Stanford, CA, USA
| | - Keri Kim
- College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Center, University of Liege, Liege, Belgium
- Department of Neurology, Centre Hospitalier Universitaire Sart Tilman, University of Liege, Liege, Belgium
| | - Ariane Lewis
- Department of Neurology and Neurosurgery, New York University Langone Health, New York, NY, USA
| | - Geoffrey Ling
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah L Livesay
- Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Victoria McCredie
- Interdepartmental Division of Critical Care, Department of Respirology, University of Toronto, Toronto, ON, Canada
| | - Molly McNett
- College of Nursing, Ohio State University, Columbus, OH, USA
| | - David Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - DaiWai Olson
- Neuroscience Intensive Care Unit, O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kristine O'Phelan
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Soojin Park
- Department of Neurology and Neurocritical Care, Columbia University, New York, NY, USA
| | - Len Polizzotto
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Jose Javier Provencio
- Department of Neurology and Neuroscience, University of Virginia, Charlottesville, VA, USA
| | - Louis Puybasset
- Department of Neuroradiology, University of Paris VI, Pierre et Marie Curie, Pitié-Salpêtrière Hospital, Paris, France
| | - Chethan P Venkatasubba Rao
- Division of Vascular Neurology and Neurocritical Care, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Courtney Robertson
- Departments of Anesthesiology and Critical Care Medicine, and Pediatrics, Johns Hopkins Children's Center, The Johns Hopkins University School of Medcine, Baltimore, MD, USA
| | - Benjamin Rohaut
- Neuroscience Intensive Care Unit, Department of Neurology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Michael Rubin
- Neurological Surgery and Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tarek Sharshar
- Department of Intensive Care, Paris Descartes University, Paris, France
| | | | - Gisele Sampaio Silva
- Hospital Israelita Albert Einstein, Academic Research Organization and Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Wade Smith
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Robert D Stevens
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Paul Vespa
- Ronald Reagan UCLA Medical Center, UCLA Santa Monica Medical Center, Santa Monica, CA, USA
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wendy C Ziai
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Zink
- Department of Neuroscience Nursing, The Johns Hopkins Hospital, The Johns Hopkins University, Baltimore, MD, USA
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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10
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Sangare A, Marois C, Perlbarg V, Pyatigorskaya N, Valente M, Zyss J, Borden A, Lambrecq V, Le Guennec L, Sitt J, Weiss N, Rohaut B, Demeret S, Puybasset L, Demoule A, Naccache L. Description and Outcome of Severe Hypoglycemic Encephalopathy in the Intensive Care Unit. Neurocrit Care 2022; 38:365-377. [PMID: 36109449 DOI: 10.1007/s12028-022-01594-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Disorders of consciousness due to severe hypoglycemia are rare but challenging to treat. The aim of this retrospective cohort study was to describe our multimodal neurological assessment of patients with hypoglycemic encephalopathy hospitalized in the intensive care unit and their neurological outcomes. METHODS Consecutive patients with disorders of consciousness related to hypoglycemia admitted for neuroprognostication from 2010 to 2020 were included. Multimodal neurological assessment included electroencephalography, somatosensory and cognitive event-related potentials, and morphological and quantitative magnetic resonance imaging (MRI) with quantification of fractional anisotropy. Neurological outcomes at 28 days, 3 months, 6 months, 1 year, and 2 years after hypoglycemia were retrieved. RESULTS Twenty patients were included. After 2 years, 75% of patients had died, 5% remained in a permanent vegetative state, 10% were in a minimally conscious state, and 10% were conscious but with severe disabilities (Glasgow Outcome Scale-Extended scores 3 and 4). All patients showed pathologic electroencephalography findings with heterogenous patterns. Morphological brain MRI revealed abnormalities in 95% of patients, with various localizations including cortical atrophy in 65% of patients. When performed, quantitative MRI showed decreased fractional anisotropy affecting widespread white matter tracts in all patients. CONCLUSIONS The overall prognosis of patients with severe hypoglycemic encephalopathy was poor, with only a small fraction of patients who slowly improved after intensive care unit discharge. Of note, patients who did not improve during the first 6 months did not recover consciousness. This study suggests that a multimodal approach capitalizing on advanced brain imaging and bedside electrophysiology techniques could improve diagnostic and prognostic performance in severe hypoglycemic encephalopathy.
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Affiliation(s)
- Aude Sangare
- Physiological Investigayions of Clinically Normal and Impaired Cognition Lab, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France.
- Département de Neurophysiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Sorbonne Université, Paris, France.
- Institut de Neurosciences Translationnelles, Paris, France.
- Brain Institute - ICM, Sorbonne Université, Inserm U1127, CNRS UMR 7225, 47 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Clémence Marois
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département de Neurologie, Médecine Intensive et Réanimation à Orientation Neurologique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
- Groupe de Recherche Clinique en Reanimation et Soins Intensifs du Patient en Insuffisance Respiratoire Aigue Assistance Publique, Sorbonne Université, Paris, France
| | | | - Nadya Pyatigorskaya
- Département de Neuroradiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Sorbonne Université, Paris, France
| | - Mélanie Valente
- Physiological Investigayions of Clinically Normal and Impaired Cognition Lab, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
- Département de Neurophysiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Sorbonne Université, Paris, France
- Institut de Neurosciences Translationnelles, Paris, France
| | - Julie Zyss
- Département de Neurophysiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Sorbonne Université, Paris, France
- Institut de Neurosciences Translationnelles, Paris, France
| | - Alaina Borden
- Département de Neurophysiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Sorbonne Université, Paris, France
- Institut de Neurosciences Translationnelles, Paris, France
| | - Virginie Lambrecq
- Département de Neurophysiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Sorbonne Université, Paris, France
- Institut de Neurosciences Translationnelles, Paris, France
| | - Loic Le Guennec
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département de Neurologie, Médecine Intensive et Réanimation à Orientation Neurologique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Jacobo Sitt
- Physiological Investigayions of Clinically Normal and Impaired Cognition Lab, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
| | - Nicolas Weiss
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département de Neurologie, Médecine Intensive et Réanimation à Orientation Neurologique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
- Groupe de Recherche Clinique en Reanimation et Soins Intensifs du Patient en Insuffisance Respiratoire Aigue Assistance Publique, Sorbonne Université, Paris, France
- Brain Liver Pitié-Salpêtrière Study Group, Centre de Recherche Saint-Antoine, Maladies Métaboliques, Biliaires et Fibro-Inflammatoire du Foie & Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - Benjamin Rohaut
- Physiological Investigayions of Clinically Normal and Impaired Cognition Lab, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département de Neurologie, Médecine Intensive et Réanimation à Orientation Neurologique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Sophie Demeret
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Département de Neurologie, Médecine Intensive et Réanimation à Orientation Neurologique, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Louis Puybasset
- Laboratoire d'Imagerie Biomédicale, Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Assistance Publique-Hôpitaux de Paris, Départements Médico-Universitaires Diagnostic, Radiologie, Explorations fonctionnelles, Anatomo-pathologie, Médecine nucléaire, Paris, France
- Department of Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Alexandre Demoule
- Neurophysiologie Respiratoire Expérimentale et Clinique, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France
- Service Médecine Intensive-Réanimation, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Lionel Naccache
- Physiological Investigayions of Clinically Normal and Impaired Cognition Lab, Institut du Cerveau et de la Moelle épinière, Sorbonne Université, Paris, France
- Département de Neurophysiologie, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Sorbonne Université, Paris, France
- Institut de Neurosciences Translationnelles, Paris, France
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11
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Kondziella D, Amiri M, Othman MH, Beghi E, Bodien YG, Citerio G, Giacino JT, Mayer SA, Lawson TN, Menon DK, Rass V, Sharshar T, Stevens RD, Tinti L, Vespa P, McNett M, Venkatasubba Rao CP, Helbok R, Akbari Y, Boly M, Dangayach N, Edlow B, Foreman B, Gilmore E, Hammond FM, Hemphill JC, Human T, Madden LK, Mainali S, Meyfroidt G, Monti M, Nakase-Richardson R, Nyquist P, Olson D, Park S, Provencio JJ, Puybasset L, Sarwal A, Shutter L, Witherspoon B, Whyte J, Ziai W. Incidence and prevalence of coma in the UK and the USA. Brain Commun 2022; 4:fcac188. [PMID: 36132425 PMCID: PMC9486895 DOI: 10.1093/braincomms/fcac188] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/19/2022] [Accepted: 07/14/2022] [Indexed: 11/14/2022] Open
Abstract
The epidemiology of coma is unknown because case ascertainment with traditional methods is difficult. Here, we used crowdsourcing methodology to estimate the incidence and prevalence of coma in the UK and the USA. We recruited UK and US laypeople (aged ≥18 years) who were nationally representative (i.e. matched for age, gender and ethnicity according to census data) of the UK and the USA, respectively, utilizing a crowdsourcing platform. We provided a description of coma and asked survey participants if they—‘right now’ or ‘within the last year’—had a family member in coma. These participants (UK n = 994, USA n = 977) provided data on 30 387 family members (UK n = 14 124, USA n = 16 263). We found more coma cases in the USA (n = 47) than in the UK (n = 20; P = 0.009). We identified one coma case in the UK (0.007%, 95% confidence interval 0.00–0.04%) on the day of the survey and 19 new coma cases (0.13%, 95% confidence interval 0.08–0.21%) within the preceding year, resulting in an annual incidence of 135/100 000 (95% confidence interval 81–210) and a point prevalence of 7 cases per 100 000 population (95% confidence interval 0.18–39.44) in the UK. We identified five cases in the USA (0.031%, 95% confidence interval 0.01–0.07%) on the day of the survey and 42 new cases (0.26%, 95% confidence interval 0.19–0.35%) within the preceding year, resulting in an annual incidence of 258/100 000 (95% confidence interval 186–349) and a point prevalence of 31 cases per 100 000 population (95% confidence interval 9.98–71.73) in the USA. The five most common causes were stroke, medically induced coma, COVID-19, traumatic brain injury and cardiac arrest. To summarize, for the first time, we report incidence and prevalence estimates for coma across diagnosis types and settings in the UK and the USA using crowdsourcing methods. Coma may be more prevalent in the USA than in the UK, which requires further investigation. These data are urgently needed to expand the public health perspective on coma and disorders of consciousness.
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Affiliation(s)
- Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital , Blegdamsvej 9 , DK-2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen , Copenhagen 2100 , Denmark
| | - Moshgan Amiri
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital , Blegdamsvej 9 , DK-2100 Copenhagen, Denmark
| | - Marwan H Othman
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital , Blegdamsvej 9 , DK-2100 Copenhagen, Denmark
| | - Ettore Beghi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS , Milan 20156 , Italy
| | - Yelena G Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School , Boston, MA 02115 , USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, MA 02114 , USA
| | - Giuseppe Citerio
- NeuroIntensive Care, ASST di Monza , Monza 20900 , Italy
- School of Medicine and Surgery, Università Milano Bicocca , Milan 20100 , Italy
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School , Boston, MA 02115 , USA
| | - Stephan A Mayer
- Department of Neurology, New York Medical College , Valhalla, NY 10595 , USA
| | - Thomas N Lawson
- College of Nursing, The Ohio State University , Columbus, OH 43210 , USA
| | - David K Menon
- Division of Anaesthesia, University of Cambridge , Cambridge CB2 2QQ , UK
| | - Verena Rass
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck , Innsbruck 6020 , Austria
| | - Tarek Sharshar
- Neuro-anesthesiology and Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University , Paris 75006 , France
- Experimental Neuropathology, Infection and Epidemiology Department, Institut Pasteur , Paris 75015 , France
| | - Robert D Stevens
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine , Baltimore, MD 21287 , USA
- Department of Neurology, The Johns Hopkins University School of Medicine , Baltimore, MD 21218 , USA
- Department of Neurosurgery, The Johns Hopkins University School of Medicine , Baltimore 21287, MD , USA
| | - Lorenzo Tinti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS , Milan 20156 , Italy
| | - Paul Vespa
- Department of Neurology, David Geffen School of Medicine at UCLA , Los Angeles, CA 90095 , USA
- Department of Neurosurgery, David Geffen School of Medicine at UCLA , Los Angeles, CA 90095 , USA
| | - Molly McNett
- College of Nursing, The Ohio State University , Columbus, OH 43210 , USA
| | - Chethan P Venkatasubba Rao
- Division of Vascular Neurology and Neurocritical Care, Baylor College of Medicine and CHI Baylor St Luke's Medical Center , Houston, TX 77030 , USA
| | - Raimund Helbok
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck , Innsbruck 6020 , Austria
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12
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Eyraud D, Creux M, Lastennet D, Lemoine L, Vaillant JC, Savier E, Vézinet C, Scatton O, Granger B, Puybasset L, Loncar Y. Restrictive intraoperative fluid intake in liver surgery and postoperative renal function: A propensity score matched study. Clin Res Hepatol Gastroenterol 2022; 46:101899. [PMID: 35257960 DOI: 10.1016/j.clinre.2022.101899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Postoperative acute kidney injury (AKI) is a common complication in hepatic surgery. In hepatic surgery, relative hypovolemia may help to limit blood loss, but the consequences of restrictive fluid intake are unknown. The goal of this study was to determine the influence of intraoperative fluid intake on the incidence of AKI and its consequences. METHODS Data from 397 consecutive patients who underwent liver resection were prospectively recorded and retrospectively analyszed. We compared the incidence of postoperative acute kidney failure in patients given restrictive (≤ 5 mL/kg/h) versus liberal (> 5 mL/kg/h) fluid therapy. We calculated a 1:1 match propensity score using logistic regression to estimate the likelihood of patients receiving restrictive or liberal intraoperative fluid intakes. The association between the intraoperative fluid intake strategy and occurrence of postoperative AKI were tested using a Cox frailty model on the database of matched patients. RESULTS Postoperative AKI was diagnosed in 133 of the 397 patients. Fluid intake strategy was restrictive for 121 patients and liberal for 276 patients. After propensity score matching to balance confounding factors, the liberal strategy was associated with a significantly lower risk for postoperative AKI compared to the restrictive strategy (Hazard Ratio 0.40 [0.29; 0.56], P<0.001). Patients with postoperative AKI had longer hospital stays and higher mortality. There were no cases of further blood loss in the liberal fluid intake group. CONCLUSIONS A restrictive fluid intake strategy is a risk factor for developing postoperative AKI, with serious consequences, without reducing blood loss in liver surgery.
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Affiliation(s)
- Daniel Eyraud
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France; Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France.
| | - Marine Creux
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Diane Lastennet
- Department of Biostatistics Public Health and Medical Informatics, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Louis Lemoine
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Jean Christophe Vaillant
- Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Eric Savier
- Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Corinne Vézinet
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Olivier Scatton
- Department of Digestive, HPB Surgery, and Liver Transplantation, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Benjamin Granger
- Department of Biostatistics Public Health and Medical Informatics, University Hospitals Pitié-Salpêtrière Charles-Foix, Sorbonne University, Paris, France
| | - Louis Puybasset
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Yann Loncar
- Department of Anesthesiology and Critical Care, GRC 29, DREAM DMU, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
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13
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Mainali S, Aiyagari V, Alexander S, Bodien Y, Boerwinkle V, Boly M, Brown E, Brown J, Claassen J, Edlow BL, Fink EL, Fins JJ, Foreman B, Frontera J, Geocadin RG, Giacino J, Gilmore EJ, Gosseries O, Hammond F, Helbok R, Claude Hemphill J, Hirsch K, Kim K, Laureys S, Lewis A, Ling G, Livesay SL, McCredie V, McNett M, Menon D, Molteni E, Olson D, O'Phelan K, Park S, Polizzotto L, Javier Provencio J, Puybasset L, Venkatasubba Rao CP, Robertson C, Rohaut B, Rubin M, Sharshar T, Shutter L, Sampaio Silva G, Smith W, Stevens RD, Thibaut A, Vespa P, Wagner AK, Ziai WC, Zink E, I Suarez J. Proceedings of the Second Curing Coma Campaign NIH Symposium: Challenging the Future of Research for Coma and Disorders of Consciousness. Neurocrit Care 2022; 37:326-350. [PMID: 35534661 PMCID: PMC9283342 DOI: 10.1007/s12028-022-01505-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/29/2022] [Indexed: 12/21/2022]
Abstract
This proceedings article presents actionable research targets on the basis of the presentations and discussions at the 2nd Curing Coma National Institutes of Health (NIH) symposium held from May 3 to May 5, 2021. Here, we summarize the background, research priorities, panel discussions, and deliverables discussed during the symposium across six major domains related to disorders of consciousness. The six domains include (1) Biology of Coma, (2) Coma Database, (3) Neuroprognostication, (4) Care of Comatose Patients, (5) Early Clinical Trials, and (6) Long-term Recovery. Following the 1st Curing Coma NIH virtual symposium held on September 9 to September 10, 2020, six workgroups, each consisting of field experts in respective domains, were formed and tasked with identifying gaps and developing key priorities and deliverables to advance the mission of the Curing Coma Campaign. The highly interactive and inspiring presentations and panel discussions during the 3-day virtual NIH symposium identified several action items for the Curing Coma Campaign mission, which we summarize in this article.
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Affiliation(s)
- Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | - Venkatesh Aiyagari
- Neurological Surgery and Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sheila Alexander
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yelena Bodien
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Varina Boerwinkle
- Division of Neurology, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Melanie Boly
- Departments of Neurology and Psychiatry, Wisconsin Institute for Sleep and Consciousness, University of Wisconsin, Madison, WI, USA
| | - Emery Brown
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeremy Brown
- Office of Emergency Care Research, Division of Clinical Research, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Jan Claassen
- Department of Neurology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Brian L Edlow
- Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Ericka L Fink
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joseph J Fins
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY, USA
- Yale Law School, New Haven, CT, USA
| | - Brandon Foreman
- Division of Neurocritical Care, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jennifer Frontera
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Romergryko G Geocadin
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph Giacino
- Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Emily J Gilmore
- Comprehensive Epilepsy Center, Department of Neurology, Yale University, New Haven, CT, USA
| | - Olivia Gosseries
- Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Flora Hammond
- Indiana University Department of Physical Medicine and Rehabilitation, University of Indiana School of Medicine, Indianapolis, IN, USA
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Claude Hemphill
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Karen Hirsch
- Division of Neurocritical Care, Department of Neurology, Stanford University, Stanford, CA, USA
| | - Keri Kim
- College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Steven Laureys
- Coma Science Group, Cyclotron Research Center, University of Liege, Liege, Belgium
- Department of Neurology, Centre Hospitalier Universitaire Sart Tilman, University of Liege, Liege, Belgium
| | - Ariane Lewis
- Department of Neurology and Neurosurgery, New York University Langone Health, New York, NY, USA
| | - Geoffrey Ling
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sarah L Livesay
- Department of Adult Health and Gerontological Nursing, College of Nursing, Rush University, Chicago, IL, USA
| | - Victoria McCredie
- Interdepartmental Division of Critical Care, Department of Respirology, University of Toronto, Toronto, ON, Canada
| | - Molly McNett
- College of Nursing, Ohio State University, Columbus, OH, USA
| | - David Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - DaiWai Olson
- Neuroscience Intensive Care Unit, O'Donnell Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kristine O'Phelan
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Soojin Park
- Department of Neurology and Neurocritical Care, Columbia University, New York, NY, USA
| | - Len Polizzotto
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Jose Javier Provencio
- Department of Neurology and Neuroscience, University of Virginia, Charlottesville, VA, USA
| | - Louis Puybasset
- Department of Neuroradiology, University of Paris VI, Pierre et Marie Curie, Pitié-Salpêtrière Hospital, Paris, France
| | - Chethan P Venkatasubba Rao
- Division of Vascular Neurology and Neurocritical Care, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Baylor College of Medicine, Houston, TX, USA
| | - Courtney Robertson
- Departments of Anesthesiology and Critical Care Medicine, and Pediatrics, Johns Hopkins Children's Center, The Johns Hopkins University School of Medcine, Baltimore, MD, USA
| | - Benjamin Rohaut
- Neuroscience Intensive Care Unit, Department of Neurology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Michael Rubin
- Neurological Surgery and Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tarek Sharshar
- Department of Intensive Care, Paris Descartes University, Paris, France
| | | | - Gisele Sampaio Silva
- Hospital Israelita Albert Einstein, Academic Research Organization and Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Wade Smith
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Robert D Stevens
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Aurore Thibaut
- Coma Science Group, GIGA Consciousness, University of Liege, Liege, Belgium
- Centre du Cerveau, University Hospital of Liege, Liege, Belgium
| | - Paul Vespa
- Ronald Reagan UCLA Medical Center, UCLA Santa Monica Medical Center, Santa Monica, CA, USA
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wendy C Ziai
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Zink
- Department of Neuroscience Nursing, The Johns Hopkins Hospital, The Johns Hopkins University, Baltimore, MD, USA
| | - Jose I Suarez
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Volovici V, Pisică D, Gravesteijn BY, Dirven CMF, Steyerberg EW, Ercole A, Stocchetti N, Nelson D, Menon DK, Citerio G, van der Jagt M, Maas AIR, Haitsma IK, Lingsma HF, Åkerlund C, Amrein K, Andelic N, Andreassen L, Audibert G, Azouvi P, Azzolini ML, Bartels R, Beer R, Bellander BM, Benali H, Berardino M, Beretta L, Beqiri E, Blaabjerg M, Lund SB, Brorsson C, Buki A, Cabeleira M, Caccioppola A, Calappi E, Calvi MR, Cameron P, Lozano GC, Castaño-León AM, Cavallo S, Chevallard G, Chieregato A, Coburn M, Coles J, Cooper JD, Correia M, Czeiter E, Czosnyka M, Dahyot-Fizelier C, Dark P, De Keyser V, Degos V, Corte FD, Boogert HD, Depreitere B, Dilvesi D, Dixit A, Dreier J, Dulière GL, Ezer E, Fabricius M, Foks K, Frisvold S, Furmanov A, Galanaud D, Gantner D, Ghuysen A, Giga L, Golubovic J, Gomez PA, Grossi F, Gupta D, Haitsma I, Helseth E, Hutchinson PJ, Jankowski S, Johnson F, Karan M, Kolias AG, Kondziella D, Koraropoulos E, Koskinen LO, Kovács N, Kowark A, Lagares A, Laureys S, Ledoux D, Lejeune A, Lightfoot R, Manara A, Martino C, Maréchal H, Mattern J, McMahon C, Menovsky T, Misset B, Muraleedharan V, Murray L, Negru A, Newcombe V, Nyirádi J, Ortolano F, Payen JF, Perlbarg V, Persona P, Piippo-Karjalainen A, Ples H, Pomposo I, Posti JP, Puybasset L, Radoi A, Ragauskas A, Raj R, Rhodes J, Richter S, Rocka S, Roe C, Roise O, Rosenfeld JV, Rosenlund C, Rosenthal G, Rossaint R, Rossi S, Sahuquillo J, Sandrød O, Sakowitz O, Sanchez-Porras R, Schirmer-Mikalsen K, Schou RF, Smielewski P, Sorinola A, Stamatakis E, Sundström N, Takala R, Tamás V, Tamosuitis T, Tenovuo O, Thomas M, Tibboel D, Tolias C, Trapani T, Tudora CM, Vajkoczy P, Vallance S, Valeinis E, Vámos Z, Van der Steen G, van Wijk RPJ, Vargiolu A, Vega E, Vik A, Vilcinis R, Vulekovic P, Williams G, Winzeck S, Wolf S, Younsi A, Zeiler FA, Ziverte A, Clusmann H, Voormolen D, van Dijck JTJM, van Essen TA. Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study. Acta Neurochir (Wien) 2022; 164:1693-1705. [PMID: 35648213 PMCID: PMC9233652 DOI: 10.1007/s00701-022-05257-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/11/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To compare outcomes between patients with primary external ventricular device (EVD)-driven treatment of intracranial hypertension and those with primary intraparenchymal monitor (IP)-driven treatment. METHODS The CENTER-TBI study is a prospective, multicenter, longitudinal observational cohort study that enrolled patients of all TBI severities from 62 participating centers (mainly level I trauma centers) across Europe between 2015 and 2017. Functional outcome was assessed at 6 months and a year. We used multivariable adjusted instrumental variable (IV) analysis with "center" as instrument and logistic regression with covariate adjustment to determine the effect estimate of EVD on 6-month functional outcome. RESULTS A total of 878 patients of all TBI severities with an indication for intracranial pressure (ICP) monitoring were included in the present study, of whom 739 (84%) patients had an IP monitor and 139 (16%) an EVD. Patients included were predominantly male (74% in the IP monitor and 76% in the EVD group), with a median age of 46 years in the IP group and 48 in the EVD group. Six-month GOS-E was similar between IP and EVD patients (adjusted odds ratio (aOR) and 95% confidence interval [CI] OR 0.74 and 95% CI [0.36-1.52], adjusted IV analysis). The length of intensive care unit stay was greater in the EVD group than in the IP group (adjusted rate ratio [95% CI] 1.70 [1.34-2.12], IV analysis). One hundred eighty-seven of the 739 patients in the IP group (25%) required an EVD due to refractory ICPs. CONCLUSION We found no major differences in outcomes of patients with TBI when comparing EVD-guided and IP monitor-guided ICP management. In our cohort, a quarter of patients that initially received an IP monitor required an EVD later for ICP control. The prevalence of complications was higher in the EVD group. PROTOCOL The core study is registered with ClinicalTrials.gov , number NCT02210221, and the Resource Identification Portal (RRID: SCR_015582).
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15
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Hain É, Chamakhi A, Lussey-Lepoutre C, Bertherat J, Baillard C, Manceau G, Puybasset L, Blacher J, Cholley B, Gimenez-Roqueplo AP, Dousset B, Amar L, Menegaux F, Gaujoux S. Perioperative outcomes of pheochromocytoma/paraganglioma surgery preceded by Takotsubo-like cardiomyopathy. Surgery 2022; 172:913-918. [PMID: 35589436 DOI: 10.1016/j.surg.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/08/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pheochromocytomas and paragangliomas can induce severe cardiovascular manifestations such as Takotsubo-like cardiomyopathy. What the perioperative outcomes are of patients presenting with pheochromocytomas/paragangliomas preceded by Takotsubo-like cardiomyopathy remains an unresolved question. METHODS From 2006 to 2019, all patients who underwent surgery for pheochromocytomas/paragangliomas preceded by Takotsubo-like cardiomyopathy were included from 3 high-volume centers, with specific attention to perioperative hemodynamic instability and postoperative outcomes. RESULTS Overall, 37 patients were included, with a median age of 45 years. Patients were operated on 2 months (1-4) after a Takotsubo-like cardiomyopathy episode; 33 (89%) had a laparoscopic approach. All those who underwent surgery presented in a hemodynamically stable situation. All except 1 of the pheochromocytomas/paragangliomas patients had at least 1 antihypertensive treatment at the time of surgery. The median preoperative systolic blood pressure in the Takotsubo-like cardiomyopathy group was 120 mm Hg (95-132). Overall, 27/34 (79%) of patients required vasoactive drugs during surgery with nicardipine (n = 22), esmolol (n = 12), and/or norepinephrine (n = 8). No patient presented a catecholamine-induced life-threatening complication such as hypertensive crisis, cardiac arrhythmias, pulmonary edema, cardiac ischemia, or Takotsubo-like cardiomyopathy in the perioperative period. Severe morbi-mortality was nil. The systematic review identified 5 studies including 38 pheochromocytomas/paragangliomas patients with at least 1 episode of acute heart failure considered as Takotsubo-like cardiomyopathy before surgery, of which 28 patients had delayed surgery with 1 postoperative death. CONCLUSION Hemodynamically stabilized patients with pheochromocytomas/paragangliomas preceded by Takotsubo-like cardiomyopathy can be safely scheduled for an elective pheochromocytomas/paragangliomas surgery, with similar intra and postoperative outcomes as those without Takotsubo-like cardiomyopathy.
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Affiliation(s)
- Élisabeth Hain
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France; Universite de Paris, Sorbonne Paris Cite, France
| | - Amine Chamakhi
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France; Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Department of General, Visceral, and Endocrine Surgery, Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Tunis El Manar University, Tunis, Tunisia
| | - Charlotte Lussey-Lepoutre
- Sorbonne University, Paris, France; Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, APHP, Paris, France; INSERM, PARCC, Équipe Labellisée par la Ligue contre le Cancer; Genetics Unit, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Jérôme Bertherat
- Universite de Paris, Sorbonne Paris Cite, France; Department of Endocrinology, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France; INSERM Unité 1016, Centre National de la Recherche Scientifique Unité Mixte de Recherche 8104, Institut Cochin, Paris, France
| | - Christophe Baillard
- Universite de Paris, Sorbonne Paris Cite, France; Department of Anesthesiology, Cochin Hospital, APHP, Paris, France
| | - Gilles Manceau
- Universite de Paris, Sorbonne Paris Cite, France; Department of Surgery, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Louis Puybasset
- Sorbonne University, Paris, France; Department of Anesthesiology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Jacques Blacher
- Universite de Paris, Sorbonne Paris Cite, France; Department of Hypertension and Cardiovascular Prevention, Hotel Dieu Hospital, AP-HP, Paris, France
| | - Bernard Cholley
- Universite de Paris, Sorbonne Paris Cite, France; Department of Anesthesiology and Critical Care Medicine, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Anne-Paule Gimenez-Roqueplo
- Universite de Paris, Sorbonne Paris Cite, France; INSERM, PARCC, Équipe Labellisée par la Ligue contre le Cancer; Genetics Unit, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Bertrand Dousset
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France; Universite de Paris, Sorbonne Paris Cite, France
| | - Laurence Amar
- Universite de Paris, Sorbonne Paris Cite, France; INSERM, PARCC, Équipe Labellisée par la Ligue contre le Cancer; Genetics Unit, AP-HP, Hôpital Européen Georges Pompidou, Paris, France; Hypertension Unit, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
| | - Fabrice Menegaux
- Department of General, Visceral, and Endocrine Surgery, Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University, Paris, France
| | - Sébastien Gaujoux
- Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris, France; Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France; Department of General, Visceral, and Endocrine Surgery, Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University, Paris, France.
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van Essen TA, Lingsma HF, Pisică D, Singh RD, Volovici V, den Boogert HF, Younsi A, Peppel LD, Heijenbrok-Kal MH, Ribbers GM, Walchenbach R, Menon DK, Hutchinson P, Depreitere B, Steyerberg EW, Maas AIR, de Ruiter GCW, Peul WC, Åkerlund C, Amrein K, Andelic N, Andreassen L, Anke A, Antoni A, Audibert G, Azouvi P, Azzolini ML, Bartels R, Barzó P, Beauvais R, Beer R, Bellander BM, Belli A, Benali H, Berardino M, Beretta L, Blaabjerg M, Bragge P, Brazinova A, Brinck V, Brooker J, Brorsson C, Buki A, Bullinger M, Cabeleira M, Caccioppola A, Calappi E, Calvi MR, Cameron P, Carbayo Lozano G, Carbonara M, Castaño-León AM, Cavallo S, Chevallard G, Chieregato A, Citerio G, Clusmann H, Coburn MS, Coles J, Cooper JD, Correia M, Čović A, Curry N, Czeiter E, Czosnyka M, Dahyot-Fizelier C, Dark P, Dawes H, De Keyser V, Degos V, Della Corte F, Đilvesi Đ, Dixit A, Donoghue E, Dreier J, Dulière GL, Ercole A, Esser P, Ezer E, Fabricius M, Feigin VL, Foks K, Frisvold S, Furmanov A, Gagliardo P, Galanaud D, Gantner D, Gao G, George P, Ghuysen A, Giga L, Glocker B, Golubović J, Gomez PA, Gratz J, Gravesteijn B, Grossi F, Gruen RL, Gupta D, Haagsma JA, Haitsma I, Helbok R, Helseth E, Horton L, Huijben J, Jacobs B, Jankowski S, Jarrett M, Jiang JY, Johnson F, Jones K, Karan M, Kolias AG, Kompanje E, Kondziella D, Kornaropoulos E, Koskinen LO, Kovács N, Lagares A, Lanyon L, Laureys S, Lecky F, Ledoux D, Lefering R, Legrand V, Lejeune A, Levi L, Lightfoot R, Maegele M, Majdan M, Manara A, Manley G, Maréchal H, Martino C, Mattern J, McMahon C, Melegh B, Menovsky T, Mikolic A, Misset B, Muraleedharan V, Murray L, Nair N, Negru A, Nelson D, Newcombe V, Nieboer D, Nyirádi J, Oresic M, Ortolano F, Otesile O, Palotie A, Parizel PM, Payen JF, Perera N, Perlbarg V, Persona P, Piippo-Karjalainen A, Pirinen M, Ples H, Polinder S, Pomposo I, Posti JP, Puybasset L, Rădoi A, Ragauskas A, Raj R, Rambadagalla M, Rehorčíková V, Retel Helmrich I, Rhodes J, Richardson S, Richter S, Ripatti S, Rocka S, Roe C, Roise O, Rosand J, Rosenfeld J, Rosenlund C, Rosenthal G, Rossaint R, Rossi S, Rueckert D, Rusnák M, Sahuquillo J, Sakowitz O, Sanchez-Porras R, Sandor J, Schäfer N, Schmidt S, Schoechl H, Schoonman G, Schou RF, Schwendenwein E, Sewalt C, Skandsen T, Smielewski P, Sorinola A, Stamatakis E, Stanworth S, Kowark A, Stevens R, Stewart W, Stocchetti N, Sundström N, Takala R, Tamás V, Tamosuitis T, Taylor MS, Te Ao B, Tenovuo O, Theadom A, Thomas M, Tibboel D, Timmers M, Tolias C, Trapani T, Tudora CM, Unterberg A, Vajkoczy P, Valeinis E, Vallance S, Vámos Z, Van der Jagt M, van der Naalt J, Van der Steen G, van Dijck JT, Van Hecke W, van Heugten C, Van Praag D, Van Veen E, van Wijk R, Vande Vyvere T, Vargiolu A, Vega E, Velt K, Verheyden J, Vespa PM, Vik A, Vilcinis R, von Steinbüchel N, Voormolen D, Vulekovic P, Wang KK, Wiegers E, Williams G, Wilson L, Winzeck S, Wolf S, Yang Z, Ylén P, Zeiler FA, Ziverte A, Zoerle T. Surgery versus conservative treatment for traumatic acute subdural haematoma: a prospective, multicentre, observational, comparative effectiveness study. Lancet Neurol 2022; 21:620-631. [DOI: 10.1016/s1474-4422(22)00166-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 01/05/2023]
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Nadjar Y, Levy P, Nguyen-Michel VH, Luyt CE, Puybasset L, Navarro V. Prognostic value of electroencephalographic paroxysms in post-anoxic coma: A new regularity EEG-based score. Neurophysiol Clin 2022; 52:223-231. [PMID: 35490145 DOI: 10.1016/j.neucli.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Several electroencephalographic (EEG) features -mainly the reactivity of background activity-have been suggested as reliable predictors of outcome for patients with post-anoxic coma (PAC). However, EEG in PAC often contains abundant EEG paroxysms (EP) that may hinder the detection of background EEG activity. We aimed to identify the features, among the different paroxysmal and non-paroxysmal EEG patterns, that may predict the outcome of patients with PAC. METHODS We retrospectively reviewed the clinical and EEG characteristics of 67 patients with PAC and selected those with abundant EP. We classified EP according to several features and assessed their prognostic value for survival at 15 days. We calculated a global regularity score, as the sum of the value (1 if regular, 0 if not) attributed to each of 4 features of EP (duration, morphology, amplitude, and frequency). RESULTS The 35 patient-group with abundant EP showed a higher mortality than the group without abundant EP. Among 12 features of EP, four regularity features (regularity of EP duration, morphology, amplitude, and global regularity score) had a poor prognostic value. A global regularity score ≥ 3 showed a positive predictive value of 100 % for a poor outcome and a negative predictive value of 54 %, with good interrater consistency (Cohen's kappa = .63). CONCLUSIONS The presence of EP and their regularity features in PAC patients are strongly associated with poor outcome. We propose a global regularity score, easily derived from visual EEG inspection, that may be a reliable prognostic tool for these patients. Prospective and larger studies are needed to confirm these findings.
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Affiliation(s)
- Yann Nadjar
- AP-HP, Epileptology Unit and Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, DMU Neuroscience, Paris 75013, France
| | - Pierre Levy
- AP-HP, Public Health Departement and Clinical Neurophysiology Unit, Tenon Hospital, Paris, France
| | - Vi-Huong Nguyen-Michel
- AP-HP, Epileptology Unit and Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, DMU Neuroscience, Paris 75013, France
| | - Charles-Edouard Luyt
- AP-HP, Medical Intensive Care Department, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France
| | - Louis Puybasset
- AP-HP, Neurosurgical Intensive Care Department, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris, France
| | - Vincent Navarro
- AP-HP, Epileptology Unit and Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, DMU Neuroscience, Paris 75013, France; Sorbonne Université, Paris, France; Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Paris Brain Institute, ICM, INSERM, CNRS, sorbonne Université, Paris, France.
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Monsel A, Hauw-Berlemont C, Mebarki M, Heming N, Mayaux J, Nguekap Tchoumba O, Diehl JL, Demoule A, Annane D, Marois C, Demeret S, Weiss E, Voiriot G, Fartoukh M, Constantin JM, Mégarbane B, Plantefève G, Malard-Castagnet S, Burrel S, Rosenzwajg M, Tchitchek N, Boucher-Pillet H, Churlaud G, Cras A, Maheux C, Pezzana C, Diallo MH, Ropers J, Menasché P, Larghero J, Benchetrit D, Bonvallot H, Charbonnier-Beaupel F, Dhib-Charfi M, Delmotte PR, Kone A, Le Corre M, Marcelin AG, Metz C, Puybasset L, Salem JE, Vezinet C. Treatment of COVID-19-associated ARDS with mesenchymal stromal cells: a multicenter randomized double-blind trial. Crit Care 2022; 26:48. [PMID: 35189925 PMCID: PMC8860258 DOI: 10.1186/s13054-022-03930-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/14/2022] [Indexed: 12/29/2022] Open
Abstract
Abstract
Background
Severe acute respiratory syndrome coronavirus-2 (SARS–CoV-2)-induced acute respiratory distress syndrome (ARDS) causes high mortality. Umbilical cord-derived mesenchymal stromal cells (UC-MSCs) have potentially relevant immune-modulatory properties, whose place in ARDS treatment is not established. This phase 2b trial was undertaken to assess the efficacy of UC-MSCs in patients with SARS–CoV-2-induced ARDS.
Methods
This multicentre, double-blind, randomized, placebo-controlled trial (STROMA–CoV-2) recruited adults (≥ 18 years) with SARS–CoV-2-induced early (< 96 h) mild-to-severe ARDS in 10 French centres. Patients were randomly assigned to receive three intravenous infusions of 106 UC-MSCs/kg or placebo (0.9% NaCl) over 5 days after recruitment. For the modified intention-to-treat population, the primary endpoint was the partial pressure of oxygen to fractional inspired oxygen (PaO2/FiO2)-ratio change between baseline (day (D) 0) and D7.
Results
Among the 107 patients screened for eligibility from April 6, 2020, to October 29, 2020, 45 were enrolled, randomized and analyzed. PaO2/FiO2 changes between D0 and D7 did not differ significantly between the UC-MSCs and placebo groups (medians [IQR] 54.3 [− 15.5 to 93.3] vs 25.3 [− 33.3 to 104.6], respectively; ANCOVA estimated treatment effect 7.4, 95% CI − 44.7 to 59.7; P = 0.77). Six (28.6%) of the 21 UC-MSCs recipients and six of 24 (25%) placebo-group patients experienced serious adverse events, none of which were related to UC-MSCs treatment.
Conclusions
D0-to-D7 PaO2/FiO2 changes for intravenous UC-MSCs-versus placebo-treated adults with SARS–CoV-2-induced ARDS did not differ significantly. Repeated UC-MSCs infusions were not associated with any serious adverse events during treatment or thereafter (until D28). Larger trials enrolling patients earlier during the course of their ARDS are needed to further assess UC-MSCs efficacy in this context.
Trial registration: NCT04333368. Registered 01 April 2020, https://clinicaltrials.gov/ct2/history/NCT04333368.
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Puybasset L, Perlbarg V, Pelegrini-Issac M. Prognostication model for traumatic brain injury based on age and white matter diffusion metrics in MRI brain. Author's reply. Intensive Care Med 2022; 48:500-501. [PMID: 35146533 DOI: 10.1007/s00134-022-06641-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Louis Puybasset
- Neurosurgical Intensive Care Unit, Hôpital Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France. .,Laboratoire d'Imagerie Biomédicale (LIB), CNRS, INSERM, Sorbonne Université, Paris, France. .,Clinical Research Group 29, Sorbonne Université, Paris, France. .,Department of Anesthesiology and Intensive Care, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
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Le Dorze M, Martin-Lefèvre L, Santin G, Robert R, Audibert G, Megarbane B, Puybasset L, Dorez D, Veber B, Kerbaul F, Antoine C. Critical pathways for controlled donation after circulatory death in France. Anaesth Crit Care Pain Med 2022; 41:101029. [PMID: 35121185 DOI: 10.1016/j.accpm.2022.101029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/22/2021] [Accepted: 12/06/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In 2015, France authorised controlled donation after circulatory death (cDCD) according to a nationally approved protocol. The aim of this study is to provide an overview from the perspective of critical care specialists of cDCD. The primary objective is to assess how the organ donation procedure affects the withdrawal of life-sustaining therapies (WLST) process. The secondary objective is to assess the impact of cDCD donors' diagnoses on the whole process. MATERIAL AND METHODS This 2015-2019 prospective observational multicentre study evaluated the WLST process in all potential cDCD donors identified nationwide, comparing 2 different sets of subgroups: 1- those whose WLST began after organ donation was ruled out vs. while it was still under consideration; 2- those with a main diagnosis of post-anoxic brain injury (PABI) vs. primary brain injury (PBI) at the time of the WLST decision. RESULTS The study analysed 908 potential cDCD donors. Organ donation remained under consideration at WLST initiation for 54.5% of them with longer intervals between their WLST decision and its initiation (2 [1-4] vs. 1 [1-2] days, P < 0.01). Overall, 60% had post-anoxic brain injury. Time from ICU admission to WLST decision was longer for primary brain injury donors (10 [4-21] vs. 6 [4-9] days, P < 0.01). Median time to death (agonal phase) was 15 [15-20] minutes. CONCLUSIONS French cDCD donors are mostly related to post-anoxic brain injury. The organ donation process does not accelerate WLST decision but increases the interval between the WLST decision and its initiation.
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Affiliation(s)
- Matthieu Le Dorze
- Université de Paris, INSERM, U942 MASCOT, F-75006, paris, france, Department of Anaesthesia and Critical Care Medicine, AP-HP, Hôpital Lariboisière, F-75010, Paris, France.
| | - Laurent Martin-Lefèvre
- Organ Donation Service, Service de Médecine Intensive Réanimation, boulevard Stéphane Moreau, 85000 La Roche-sur-Yon, France
| | - Gaëlle Santin
- Agence de la biomédecine, Medical and Scientific Department, 1, avenue du stade de France, 93212 Saint-Denis, France
| | - René Robert
- University of Poitiers, CHU de Poitiers, Service de Médecine Intensive Réanimation, CIC Inserm 1402, 2, rue de la Milétrie, 86021 Poitiers, France
| | - Gérard Audibert
- University of Lorraine, Department of Anaesthesiology and Critical Care Medicine, Nancy University Hospital, 29, avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France
| | - Bruno Megarbane
- University of Paris, INSERM UMRS-1144, Department of Medical and Toxicological Critical Care, AP-HP, Lariboisière Hospital, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - Louis Puybasset
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care Medicine, AP-HP, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Didier Dorez
- Organ Donation Service, Centre Hospitalier Annecy-genevois, 1, avenue de l'Hôpital, 74370 Epagny Metz-Tessy, France
| | - Benoît Veber
- SFAR Ethics Committee, Surgical Intensive Care Unit, Rouen University Hospital, 37, boulevard Gambetta, 76000 Rouen, France
| | - François Kerbaul
- Agence de la biomédecine, Medical and Scientific Department, 1, avenue du stade de France, 93212 Saint-Denis, France
| | - Corinne Antoine
- Agence de la biomédecine, Medical and Scientific Department, 1, avenue du stade de France, 93212 Saint-Denis, France
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21
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Van Praag DL, Wouters K, Van Den Eede F, Wilson L, Maas AI, Åkerlund C, Amrein K, Andelic N, Andreassen L, Anke A, Antoni A, Audibert G, Azouvi P, Azzolini ML, Bartels R, Barzó P, Beauvais R, Beer R, Bellander BM, Belli A, Benali H, Berardino M, Beretta L, Blaabjerg M, Bragge P, Brazinova A, Brinck V, Brooker J, Brorsson C, Buki A, Bullinger M, Cabeleira M, Caccioppola A, Calappi E, Calvi MR, Cameron P, Lozano GC, Carbonara M, Cavallo S, Chevallard G, Chieregato A, Citerio G, Ceyisakar I, Clusmann H, Coburn M, Coles J, Cooper JD, Correia M, Čović A, Curry N, Czeiter E, Czosnyka M, Dahyot-Fizelier C, Dark P, Dawes H, De Keyser V, Degos V, Della Corte F, Boogert HD, Depreitere B, Đilvesi Đ, Dixit A, Donoghue E, Dreier J, Dulière GL, Ercole A, Esser P, Ezer E, Fabricius M, Feigin VL, Foks K, Frisvold S, Furmanov A, Gagliardo P, Galanaud D, Gantner D, Gao G, George P, Ghuysen A, Giga L, Glocker B, Golubovic J, Gomez PA, Gratz J, Gravesteijn B, Grossi F, Gruen RL, Gupta D, Haagsma JA, Haitsma I, Helbok R, Helseth E, Horton L, Huijben J, Hutchinson PJ, Jacobs B, Jankowski S, Jarrett M, Jiang JY, Johnson F, Jones K, Karan M, Kolias AG, Kompanje E, Kondziella D, Koraropoulos E, Koskinen LO, Kovács N, Kowark A, Lagares A, Lanyon L, Laureys S, Lecky F, Ledoux D, Lefering R, Legrand V, Lejeune A, Levi L, Lightfoot R, Lingsma H, Maas AI, Castaño-León AM, Maegele M, Majdan M, Manara A, Manley G, Martino C, Maréchal H, Mattern J, McMahon C, Melegh B, Menon D, Menovsky T, Mikolic A, Misset B, Muraleedharan V, Murray L, Negru A, Nelson D, Newcombe V, Nieboer D, Nyirádi J, Olubukola O, Oresic M, Ortolano F, Palotie A, Parizel PM, Payen JF, Perera N, Perlbarg V, Persona P, Peul W, Piippo-Karjalainen A, Pirinen M, Ples H, Polinder S, Pomposo I, Posti JP, Puybasset L, Radoi A, Ragauskas A, Raj R, Rambadagalla M, Rhodes J, Richardson S, Richter S, Ripatti S, Rocka S, Roe C, Roise O, Rosand J, Rosenfeld JV, Rosenlund C, Rosenthal G, Rossaint R, Rossi S, Rueckert D, Rusnák M, Sahuquillo J, Sakowitz O, Sanchez-Porras R, Sandor J, Schäfer N, Schmidt S, Schoechl H, Schoonman G, Schou RF, Schwendenwein E, Sewalt C, Skandsen T, Smielewski P, Sorinola A, Stamatakis E, Stanworth S, Stevens R, Stewart W, Steyerberg EW, Stocchetti N, Sundström N, Synnot A, Takala R, Tamás V, Tamosuitis T, Taylor MS, Ao BT, Tenovuo O, Theadom A, Thomas M, Tibboel D, Timmers M, Tolias C, Trapani T, Tudora CM, Unterberg A, Vajkoczy P, Vallance S, Valeinis E, Vámos Z, van der Jagt M, Van der Steen G, van der Naalt J, van Dijck JT, van Essen TA, Van Hecke W, van Heugten C, Van Praag D, Vyvere TV, van Wijk RP, Vargiolu A, Vega E, Velt K, Verheyden J, Vespa PM, Vik A, Vilcinis R, Volovici V, von Steinbüchel N, Voormolen D, Vulekovic P, Wang KK, Wiegers E, Williams G, Wilson L, Winzeck S, Wolf S, Yang Z, Ylén P, Younsi A, Zeiler FA, Zelinkova V, Ziverte A, Zoerle T. Neurocognitive correlates of probable posttraumatic stress disorder following traumatic brain injury. Brain and Spine 2022; 2:100854. [PMID: 36248103 PMCID: PMC9560676 DOI: 10.1016/j.bas.2021.100854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/07/2021] [Accepted: 12/16/2021] [Indexed: 01/17/2023]
Abstract
Introduction Neurocognitive problems associated with posttraumatic stress disorder (PTSD) can interact with impairment resulting from traumatic brain injury (TBI). Research question We aimed to identify neurocognitive problems associated with probable PTSD following TBI in a civilian sample. Material and methods The study is part of the CENTER-TBI project (Collaborative European Neurotrauma Effectiveness Research) that aims to better characterize TBI. For this cross-sectional study, we included patients of all severities aged over 15, and a Glasgow Outcome Score Extended (GOSE) above 3. Participants were assessed at six months post-injury on the PTSD Checklist-5 (PCL-5), the Trail Making Test (TMT), the Rey Auditory Verbal Learning Test (RAVLT) and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Primary analysis was a complete case analysis. Regression analyses were performed to investigate the association between the PCL-5 and cognition. Results Of the 1134 participants included in the complete case analysis, 13.5% screened positive for PTSD. Probable PTSD was significantly associated with higher TMT-(B-A) (OR = 1.35, 95% CI: 1.14–1.60, p < .001) and lower RAVLT-delayed recall scores (OR = 0.74, 95% CI: 0.61–0.91, p = .004) after controlling for age, sex, psychiatric history, baseline Glasgow Coma Scale and education. Discussion and conclusion Poorer performance on cognitive tests assessing task switching and, to a lesser extent, delayed verbal recall is associated with probable PTSD in civilians who have suffered TBI. Six months after traumatic brain injury 13.5% of people screen positive for PTSD. Task switching performance and verbal memory are related to probable PTSD. PTSD severity is related to processing speed and task switching performance.
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22
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Schmidt M, Guidet B, Demoule A, Ponnaiah M, Fartoukh M, Puybasset L, Combes A, Hajage D. Predicting 90-day survival of patients with COVID-19: Survival of Severely Ill COVID (SOSIC) scores. Ann Intensive Care 2021; 11:170. [PMID: 34897559 PMCID: PMC8665857 DOI: 10.1186/s13613-021-00956-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Predicting outcomes of critically ill intensive care unit (ICU) patients with coronavirus-19 disease (COVID-19) is a major challenge to avoid futile, and prolonged ICU stays. METHODS The objective was to develop predictive survival models for patients with COVID-19 after 1-to-2 weeks in ICU. Based on the COVID-ICU cohort, which prospectively collected characteristics, management, and outcomes of critically ill patients with COVID-19. Machine learning was used to develop dynamic, clinically useful models able to predict 90-day mortality using ICU data collected on day (D) 1, D7 or D14. RESULTS Survival of Severely Ill COVID (SOSIC)-1, SOSIC-7, and SOSIC-14 scores were constructed with 4244, 2877, and 1349 patients, respectively, randomly assigned to development or test datasets. The three models selected 15 ICU-entry variables recorded on D1, D7, or D14. Cardiovascular, renal, and pulmonary functions on prediction D7 or D14 were among the most heavily weighted inputs for both models. For the test dataset, SOSIC-7's area under the ROC curve was slightly higher (0.80 [0.74-0.86]) than those for SOSIC-1 (0.76 [0.71-0.81]) and SOSIC-14 (0.76 [0.68-0.83]). Similarly, SOSIC-1 and SOSIC-7 had excellent calibration curves, with similar Brier scores for the three models. CONCLUSION The SOSIC scores showed that entering 15 to 27 baseline and dynamic clinical parameters into an automatable XGBoost algorithm can potentially accurately predict the likely 90-day mortality post-ICU admission (sosic.shinyapps.io/shiny). Although external SOSIC-score validation is still needed, it is an additional tool to strengthen decisions about life-sustaining treatments and informing family members of likely prognosis.
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Affiliation(s)
- Matthieu Schmidt
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France. .,Service de Médecine Intensive-Réanimation, Institut de Cardiologie, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), 47, bd de l'Hôpital, 75651, Paris Cedex 13, France. .,Sorbonne Université, GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Bertrand Guidet
- Sorbonne Université, GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Paris, France.,Institut Pierre-Louis d'Epidémiologie et de Santé Publique, APHP, Hôpital Saint-Antoine, INSERM, Service de Réanimation, Sorbonne Université, Paris, France
| | - Alexandre Demoule
- Sorbonne Université, GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Paris, France.,Service de Pneumologie, Médecine Intensive-Réanimation (Département R3S), Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM UMRS_1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Maharajah Ponnaiah
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Muriel Fartoukh
- Sorbonne Université, GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Paris, France.,Service de Médecine Intensive-Réanimation, Hôpital Tenon, Département Médico-Universitaire APPROCHES, APHP, Paris, France.,Groupe de Recherche Clinique CARMAS, Université Paris-Est Créteil, Créteil, France
| | - Louis Puybasset
- CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France.,Department of Anesthesiology & Critical Care, APHP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Alain Combes
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Mixte de Recherche (UMRS) 1166, Institute of Cardiometabolism and Nutrition, Paris, France.,Service de Médecine Intensive-Réanimation, Institut de Cardiologie, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), 47, bd de l'Hôpital, 75651, Paris Cedex 13, France.,Sorbonne Université, GRC 30, RESPIRE, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - David Hajage
- Département de Santé Publique, Centre de Pharmacoépidémiologie (Cephepi), INSER, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, APHP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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23
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Pérez P, Madsen J, Banellis L, Türker B, Raimondo F, Perlbarg V, Valente M, Niérat MC, Puybasset L, Naccache L, Similowski T, Cruse D, Parra LC, Sitt JD. Conscious processing of narrative stimuli synchronizes heart rate between individuals. Cell Rep 2021; 36:109692. [PMID: 34525363 DOI: 10.1016/j.celrep.2021.109692] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 06/15/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022] Open
Abstract
Heart rate has natural fluctuations that are typically ascribed to autonomic function. Recent evidence suggests that conscious processing can affect the timing of the heartbeat. We hypothesized that heart rate is modulated by conscious processing and therefore dependent on attentional focus. To test this, we leverage the observation that neural processes synchronize between subjects by presenting an identical narrative stimulus. As predicted, we find significant inter-subject correlation of heart rate (ISC-HR) when subjects are presented with an auditory or audiovisual narrative. Consistent with our hypothesis, we find that ISC-HR is reduced when subjects are distracted from the narrative, and higher ISC-HR predicts better recall of the narrative. Finally, patients with disorders of consciousness have lower ISC-HR, as compared to healthy individuals. We conclude that heart rate fluctuations are partially driven by conscious processing, depend on attentional state, and may represent a simple metric to assess conscious state in unresponsive patients.
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Affiliation(s)
- Pauline Pérez
- Paris Brain Institute, ICM, 75013 Paris, France; Inserm U 1127, 75013 Paris, France; CNRS UMR 7225, 75013 Paris, France
| | - Jens Madsen
- Department of Biomedical Engineering, City College of New York, New York, NY, USA
| | - Leah Banellis
- School of Psychology, University of Birmingham, Birmingham B15 2TT, England; Centre for Human Brain Health, University of Birmingham, Birmingham B15 2TT, England
| | - Bașak Türker
- Paris Brain Institute, ICM, 75013 Paris, France; Inserm U 1127, 75013 Paris, France; CNRS UMR 7225, 75013 Paris, France
| | | | - Vincent Perlbarg
- Bioinformatics and Biostatistics Core Facility, iCONICS, IHU-A-ICM, Institut du Cerveau et de la Moelle épinière, Paris, France
| | | | - Marie-Cécile Niérat
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005 Paris, France
| | - Louis Puybasset
- Department of Anesthesia and Intensive Care, Pitié-Salpetrière Hospital, Paris, France; Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Lionel Naccache
- Paris Brain Institute, ICM, 75013 Paris, France; Inserm U 1127, 75013 Paris, France; CNRS UMR 7225, 75013 Paris, France; Department of Neurophysiology, Hôpital de la Pitié-Salpetrière, AP-HP, 75013 Paris, France; Faculté de Médecine Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75005 Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), 75013 Paris, France
| | - Damian Cruse
- School of Psychology, University of Birmingham, Birmingham B15 2TT, England; Centre for Human Brain Health, University of Birmingham, Birmingham B15 2TT, England
| | - Lucas C Parra
- Department of Biomedical Engineering, City College of New York, New York, NY, USA.
| | - Jacobo D Sitt
- Paris Brain Institute, ICM, 75013 Paris, France; Inserm U 1127, 75013 Paris, France; CNRS UMR 7225, 75013 Paris, France.
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24
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van der Eerden AW, van den Heuvel TL, Perlbarg V, Vart P, Vos PE, Puybasset L, Galanaud D, Platel B, Manniesing R, Goraj BM. Traumatic Cerebral Microbleeds in the Subacute Phase Are Practical and Early Predictors of Abnormality of the Normal-Appearing White Matter in the Chronic Phase. AJNR Am J Neuroradiol 2021; 42:861-867. [PMID: 33632731 DOI: 10.3174/ajnr.a7028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE In the chronic phase after traumatic brain injury, DTI findings reflect WM integrity. DTI interpretation in the subacute phase is less straightforward. Microbleed evaluation with SWI is straightforward in both phases. We evaluated whether the microbleed concentration in the subacute phase is associated with the integrity of normal-appearing WM in the chronic phase. MATERIALS AND METHODS Sixty of 211 consecutive patients 18 years of age or older admitted to our emergency department ≤24 hours after moderate to severe traumatic brain injury matched the selection criteria. Standardized 3T SWI, DTI, and T1WI were obtained 3 and 26 weeks after traumatic brain injury in 31 patients and 24 healthy volunteers. At baseline, microbleed concentrations were calculated. At follow-up, mean diffusivity (MD) was calculated in the normal-appearing WM in reference to the healthy volunteers (MDz). Through linear regression, we evaluated the relation between microbleed concentration and MDz in predefined structures. RESULTS In the cerebral hemispheres, MDz at follow-up was independently associated with the microbleed concentration at baseline (left: B = 38.4 [95% CI 7.5-69.3], P = .017; right: B = 26.3 [95% CI 5.7-47.0], P = .014). No such relation was demonstrated in the central brain. MDz in the corpus callosum was independently associated with the microbleed concentration in the structures connected by WM tracts running through the corpus callosum (B = 20.0 [95% CI 24.8-75.2], P < .000). MDz in the central brain was independently associated with the microbleed concentration in the cerebral hemispheres (B = 25.7 [95% CI 3.9-47.5], P = .023). CONCLUSIONS SWI-assessed microbleeds in the subacute phase are associated with DTI-based WM integrity in the chronic phase. These associations are found both within regions and between functionally connected regions.
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Affiliation(s)
- A W van der Eerden
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands .,Erasmus Medical Center, Department of Radiology & Nuclear Medicine (A.W.v.d.E.), Rotterdam, The Netherlands
| | - T L van den Heuvel
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - V Perlbarg
- Inserm, Sorbonne Université (V.P.), CNRS, Laboratoire d'Imagerie Biomédicale, Paris, France.,BrainTale SAS (V.P.), Paris, France
| | - P Vart
- Department of Epidemiology and Biostatistics (P.V.), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - P E Vos
- Department of Neurology (P.E.V.), Santiz-Slingeland Hospital, Doetinchem, The Netherlands
| | - L Puybasset
- Department of Neurosurgical ICU (L.P.), Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D Galanaud
- Department of Neuroradiology (D.G.), Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - B Platel
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Manniesing
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - B M Goraj
- From the Department of Radiology and Nuclear Medicine (A.W.v.d.E., T.L.v.d.H., B.P., R.M., B.M.G.), Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Diagnostic Imaging (B.M.G.), Medical Centre of Postgraduate Education, Warsaw, Poland
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25
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Debarle C, Perlbarg V, Jacquens A, Pélégrini-Issac M, Bisch M, Prigent A, Lesimple B, Caron E, Lefort M, Bayen E, Galanaud D, Pradat-Diehl P, Puybasset L, Degos V. Global mean diffusivity: A radiomarker discriminating good outcome long term after traumatic brain injury. Ann Phys Rehabil Med 2021; 64:101433. [PMID: 32992024 DOI: 10.1016/j.rehab.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 07/29/2020] [Accepted: 08/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is a chronic pathology responsible for cognitive disorders impacting outcome. Global clinical outcome several years after TBI may be associated with anatomical sequelae. Anatomical lesions are not well described because characterizing diffuse axonal injury and brain atrophy require using specific MRI sequences with quantitative measures. The best radiologic parameter to describe the lesions long term after TBI is not known. OBJECTIVE We aimed to first, assess the global volumetric and diffusion parameters related to long-term outcome after TBI and second, define the most discriminating parameter. METHODS In this observational study, we included 96 patients with severe TBI and 22 healthy volunteers. The mean delay after TBI was 63.2 months [range 31-119]. The Glasgow Outcome Scale Extended (GOS-E) was used to assess the global long-term clinical outcome. All patients underwent multimodal MRI with measures of brain volume, ventricle volume, global fractional anisotropy (FA) and global mean diffusivity (MD). RESULTS All 96 participants had significant impairment in global FA, global MD, brain volume and ventricle volume as compared with the 22 controls (P<0.01). Only global MD significantly differed between the "good recovery" group (GOS-E score 7-8) and the other two groups: GOS-E scores 3-4 and 5-6. Brain volume significantly differed between the GOS-E 7-8 and 3-4 groups. Global MD was the most discriminating radiological parameter for the "good recovery" group versus other patients, long term after TBI. FA appeared less relevant at this time. Global atrophy was higher in patients than controls but lacked reliability to discriminate groups of patients. CONCLUSION Global mean diffusivity seems a more promising radiomarker than global FA for discriminating good outcome long term after TBI. Further work is needed to understand the evolution of these long-term radiological parameters after TBI.
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Affiliation(s)
- Clara Debarle
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Physical Medicine and Rehabilitation Department, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif and Réadaptation (HaMCRe), Paris, France.
| | - Vincent Perlbarg
- BRAINTALE SAS, Paris, France; Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Alice Jacquens
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France; Sorbonne Université, Groupe de Recherche Clinique Biosfast, Paris, France
| | | | - Marion Bisch
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France
| | - Amélie Prigent
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France
| | - Blandine Lesimple
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France
| | - Elsa Caron
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Physical Medicine and Rehabilitation Department, Paris, France
| | - Muriel Lefort
- Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Eléonore Bayen
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Physical Medicine and Rehabilitation Department, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif and Réadaptation (HaMCRe), Paris, France
| | - Damien Galanaud
- Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France; AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neuroradiological Department, Paris, France
| | - Pascale Pradat-Diehl
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Physical Medicine and Rehabilitation Department, Paris, France; Sorbonne Université, GRC n°24, Handicap Moteur et Cognitif and Réadaptation (HaMCRe), Paris, France; Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Louis Puybasset
- Inserm, Sorbonne Université, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France; AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France
| | - Vincent Degos
- AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Neurosurgical Department, NeuroIntensive Care Unit, Paris, France; Sorbonne Université, Groupe de Recherche Clinique Biosfast, Paris, France
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26
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Sangare A, Dong A, Valente M, Pyatigorskaya N, Cao A, Altmayer V, Zyss J, Lambrecq V, Roux D, Morlon Q, Perez P, Ben Salah A, Virolle S, Puybasset L, Sitt JD, Rohaut B, Naccache L. Neuroprognostication of Consciousness Recovery in a Patient with COVID-19 Related Encephalitis: Preliminary Findings from a Multimodal Approach. Brain Sci 2020; 10:E845. [PMID: 33198199 PMCID: PMC7696159 DOI: 10.3390/brainsci10110845] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 12/17/2022] Open
Abstract
Predicting the functional recovery of patients with severe neurological condition due to coronavirus disease 2019 (COVID-19) is a challenging task. Only limited outcome data are available, the pathophysiology is poorly understood, and the time-course of recovery is still largely unknown. Here, we report the case of a patient with COVID-19 associated encephalitis presenting as a prolonged state of unresponsiveness for two months, who finally fully recovered consciousness, functional communication, and autonomy after immunotherapy. In a multimodal approach, a high-density resting state EEG revealed a rich brain activity in spite of a severe clinical presentation. Using our previously validated algorithms, we could predict a possible improvement of consciousness in this patient. This case report illustrates the value of a multimodal approach capitalizing on advanced brain-imaging and bedside electrophysiology techniques to improve prognosis accuracy in this complex and new aetiology.
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Affiliation(s)
- Aude Sangare
- Brain institute—ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, 75013 Paris, France; (M.V.); (N.P.); (V.L.); (P.P.); (A.B.S.); (J.D.S.); (B.R.); (L.N.)
- CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, Sorbonne Université, 75006 Paris, France; (A.C.); (L.P.)
- Department of Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France;
| | - Anceline Dong
- Department of Neurology, Neuro-ICU, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France; (A.D.); (V.A.)
| | - Melanie Valente
- Brain institute—ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, 75013 Paris, France; (M.V.); (N.P.); (V.L.); (P.P.); (A.B.S.); (J.D.S.); (B.R.); (L.N.)
| | - Nadya Pyatigorskaya
- Brain institute—ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, 75013 Paris, France; (M.V.); (N.P.); (V.L.); (P.P.); (A.B.S.); (J.D.S.); (B.R.); (L.N.)
- CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, Sorbonne Université, 75006 Paris, France; (A.C.); (L.P.)
- Department of Neuroradiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France
| | - Albert Cao
- CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, Sorbonne Université, 75006 Paris, France; (A.C.); (L.P.)
- Department of Neurology, Neuro-ICU, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France; (A.D.); (V.A.)
| | - Victor Altmayer
- Department of Neurology, Neuro-ICU, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France; (A.D.); (V.A.)
| | - Julie Zyss
- Department of Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France;
| | - Virginie Lambrecq
- Brain institute—ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, 75013 Paris, France; (M.V.); (N.P.); (V.L.); (P.P.); (A.B.S.); (J.D.S.); (B.R.); (L.N.)
- CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, Sorbonne Université, 75006 Paris, France; (A.C.); (L.P.)
- Department of Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France;
| | - Damien Roux
- Department of Critical Care, Hôpital Louis Mourier, AP-HP, Université de Paris, 92700 Colombes, France; (D.R.); (Q.M.)
| | - Quentin Morlon
- Department of Critical Care, Hôpital Louis Mourier, AP-HP, Université de Paris, 92700 Colombes, France; (D.R.); (Q.M.)
| | - Pauline Perez
- Brain institute—ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, 75013 Paris, France; (M.V.); (N.P.); (V.L.); (P.P.); (A.B.S.); (J.D.S.); (B.R.); (L.N.)
- Department of Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France;
| | - Amina Ben Salah
- Brain institute—ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, 75013 Paris, France; (M.V.); (N.P.); (V.L.); (P.P.); (A.B.S.); (J.D.S.); (B.R.); (L.N.)
- Department of Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France;
| | - Sara Virolle
- Department of Pneumology, post ICU rehabilitation, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France;
| | - Louis Puybasset
- CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, Sorbonne Université, 75006 Paris, France; (A.C.); (L.P.)
- Department of Anesthesiology & Critical Care, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France
| | - Jacobo D Sitt
- Brain institute—ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, 75013 Paris, France; (M.V.); (N.P.); (V.L.); (P.P.); (A.B.S.); (J.D.S.); (B.R.); (L.N.)
- CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, Sorbonne Université, 75006 Paris, France; (A.C.); (L.P.)
| | - Benjamin Rohaut
- Brain institute—ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, 75013 Paris, France; (M.V.); (N.P.); (V.L.); (P.P.); (A.B.S.); (J.D.S.); (B.R.); (L.N.)
- CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, Sorbonne Université, 75006 Paris, France; (A.C.); (L.P.)
- Department of Neurology, Neuro-ICU, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France; (A.D.); (V.A.)
- Department of Neurology, Columbia University, New York, NY 10027, USA
| | - Lionel Naccache
- Brain institute—ICM, Inserm U1127, CNRS UMR 7225, Sorbonne Université, 75013 Paris, France; (M.V.); (N.P.); (V.L.); (P.P.); (A.B.S.); (J.D.S.); (B.R.); (L.N.)
- CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, Sorbonne Université, 75006 Paris, France; (A.C.); (L.P.)
- Department of Neurophysiology, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75006 Paris, France;
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27
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Payen JF, Richard M, Francony G, Audibert G, Barbier EL, Bruder N, Dahyot-Fizelier C, Geeraerts T, Gergele L, Puybasset L, Vigue B, Skaare K, Bosson JL, Bouzat P. Comparison of strategies for monitoring and treating patients at the early phase of severe traumatic brain injury: the multicentre randomised controlled OXY-TC trial study protocol. BMJ Open 2020; 10:e040550. [PMID: 32820002 PMCID: PMC7443301 DOI: 10.1136/bmjopen-2020-040550] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Intracranial hypertension is considered as an independent risk factor of mortality and neurological disabilities after severe traumatic brain injury (TBI). However, clinical studies have demonstrated that episodes of brain ischaemia/hypoxia are common despite normalisation of intracranial pressure (ICP). This study assesses the impact on neurological outcome of guiding therapeutic strategies based on the monitoring of both brain tissue oxygenation pressure (PbtO2) and ICP during the first 5 days following severe TBI. METHODS AND ANALYSIS Multicentre, open-labelled, randomised controlled superiority trial with two parallel groups in 300 patients with severe TBI. Intracerebral monitoring must be in place within the first 16 hours post-trauma. Patients are randomly assigned to the ICP group or to the ICP + PbtO2 group. The ICP group is managed according to the international guidelines to maintain ICP≤20 mm Hg. The ICP + PbtO2 group is managed to maintain PbtO2 ≥20 mm Hg in addition to the conventional optimisation of ICP. The primary outcome measure is the neurological status at 6 months as assessed using the extended Glasgow Outcome Scale. Secondary outcome measures include quality-of-life assessment, mortality rate, therapeutic intensity and incidence of critical events during the first 5 days. Analysis will be performed according to the intention-to-treat principle and full statistical analysis plan developed prior to database freeze. ETHICS AND DISSEMINATION This study has been approved by the Institutional Review Board of Sud-Est V (14-CHUG-48) and from the National Agency for Medicines and Health Products Safety (Agence Nationale de Sécurité du Médicament et des produits de santé) (141 435B-31). Results will be presented at scientific meetings and published in peer-reviewed publications.The study was registered with ClinTrials NCT02754063 on 28 April 2016 (pre-results).
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Affiliation(s)
- Jean-Francois Payen
- Department of Anaesthesia and Intensive Care, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, INSERM, U1216, Grenoble, France
| | - Marion Richard
- Department of Anaesthesia and Intensive Care, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, INSERM, U1216, Grenoble, France
| | - Gilles Francony
- Department of Anaesthesia and Intensive Care, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, INSERM, U1216, Grenoble, France
| | - Gérard Audibert
- Department of Anaesthesia and Intensive Care, Lorraine University, Nancy University Hospital, Nancy, France
| | - Emmanuel L Barbier
- Department of Anaesthesia and Intensive Care, Univ. Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Institut des Neurosciences, INSERM, U1216, Grenoble, France
| | - Nicolas Bruder
- Department of Anaesthesiology and Intensive Care, Aix-Marseille University, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Claire Dahyot-Fizelier
- Department of Anaesthesia and Intensive Care, Poitiers University Hospital and Poitiers Hospital, Pharmacology of antimicrobial agents, INSERM U1070, Poitiers, France
| | - Thomas Geeraerts
- Department of Anaesthesia and Intensive Care, Toulouse University Hospital and Toulouse 3-Paul Sabatier University, Toulouse, France
| | - Laurent Gergele
- Department of Intensive care, Ramsay Sante, Hopital Privé de la Loire, Saint-Etienne, France
| | - Louis Puybasset
- Department of Anaesthesia and Critical Care, Sorbonne University, GRC 29, AP-HP, DMU DREAM, Pitié-Salpêtrière Hospital, Paris, France
| | - Bernard Vigue
- Department of Anaesthesia and Intensive care, Centre Hospitalier Universitaire de Bicêtre, Assistance Publique - Hopitaux de Paris, Le Kremlin Bicêtre, France
| | - Kristina Skaare
- Department of Public Health, Univ. Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Jean Luc Bosson
- TIMC IMAG, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Pierre Bouzat
- Centre Hospitalier Universitaire de Grenoble, Grenoble, France
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28
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Feng J, van Veen E, Yang C, Huijben JA, Lingsma HF, Gao G, Jiang J, Maas AI, Åkerlund C, Amrein K, Andelic N, Andreassen L, Anke A, Antoni A, Audibert G, Azouvi P, Azzolini ML, Bartels R, Barzó P, Beauvais R, Beer R, Bellander BM, Belli A, Benali H, Berardino M, Beretta L, Blaabjerg M, Bragge P, Brazinova A, Brinck V, Brooker J, Brorsson C, Buki A, Bullinger M, Cabeleira M, Caccioppola A, Calappi E, Calvi MR, Cameron P, Lozano GC, Carbonara M, Cavallo S, Chevallard G, Chieregato A, Citerio G, Care N, Ceyisakar I, Clusmann H, Coburn M, Coles J, Cooper JD, Correia M, Čović A, Curry N, Czeiter E, Czosnyka M, Dahyot-Fizelier C, Dark P, Dawes H, De Keyser V, Degos V, Corte FD, den Boogert H, Depreitere B, Đilvesi Đ, Dixit A, Donoghue E, Dreier J, Dulière GL, Ercole A, Esser P, Ezer E, Fabricius M, Feigin VL, Foks K, Frisvold S, Furmanov A, Gagliardo P, Galanaud, George P, Ghuysen A, Giga L, Glocker B, Golubovic J, Gomez PA, Gratz J, Gravesteijn B, Grossi F, Gruen RL, Gupta D, Haagsma JA, Haitsma I, Helbok R, Helseth E, Horton L, Hutchinson PJ, Jacobs B, Jankowski S, Jarrett M, Johnson F, Jones K, Karan M, Kolias AG, Kompanje E, Kondziella D, Koraropoulos E, Koskinen LO, Kovács N, Kowark A, Lagares A, Lanyon L, Laureys S, Lecky F, Department E, Ledoux D, Lefering R, Legrand V, Lejeune A, Levi L, Lightfoot R, Castaño-León AM, Maegele M, Majdan M, Manara A, Manley G, Martino C, Maréchal H, Mattern J, McMahon C, Melegh B, Menon D, Menovsky T, Mikolic A, Misset B, Muraleedharan V, Murray L, Negru A, Nelson D, Newcombe V, Nieboer D, Nyirádi J, Olubukola O, Oresic M, Ortolano F, Palotie A, Parizel PM, Payen JF, Perera N, Perlbarg V, Persona P, Peul W, Piippo-Karjalainen A, Pirinen M, Ples H, Polinder S, Pomposo I, Posti JP, Puybasset L, Radoi A, Ragauskas A, Raj R, Rambadagalla M, Rhodes J, Richardson S, Richter S, Ripatti S, Rocka S, Roe C, Roise O, Rosand J, Rosenfeld JV, Rosenlund C, Rosenthal G, Rossaint R, Rossi S, Rueckert D, Rusnák M, Sahuquillo J, Sakowitz O, Sanchez-Porras R, Sandor J, Schäfer N, Schmidt S, Schoechl H, Schoonman G, Schou RF, Schwendenwein E, Sewalt C, Skandsen T, Smielewski P, Sorinola A, Stamatakis E, Stanworth S, Stevens R, Stewart W, Steyerberg EW, Stocchetti N, Sundström N, Synnot A, Takala R, Tamás V, Tamosuitis T, Taylor MS, Ao BT, Tenovuo O, Theadom A, Thomas M, Tibboel D, Timmers M, Tolias C, Trapani T, Tudora CM, Vajkoczy P, Vallance S, Valeinis E, Vámos Z, van der Jagt M, Van der Steen G, van der Naalt J, van Dijck JT, van Essen TA, Van Hecke W, van Heugten C, Van Praag D, Vyvere TV, van Wijk RPJ, Vargiolu A, Vega E, Velt K, Verheyden J, Vespa PM, Vik A, Vilcinis R, Volovici V, von Steinbüchel N, Voormolen D, Vulekovic P, Wang KK, Wiegers E, Williams G, Wilson L, Winzeck S, Wolf S, Yang Z, Ylén P, Younsi A, Zeiler FA, Zelinkova V, Ziverte A, Zoerle T, Ma Y, Kang W, Fu S, Luan Y, Qin H, Sun Z, Guo H, Tian H, Ju S, Xu Y, Wei Q, Zhang S, Tu Y, Wang D, Zhang L, Long L, Jiang C, Yang X, Wen L, Liu K, Xu L, Liu J, Sun Z, Chen L, Jiang Y, Xu W, Gao Y, Jiang R, Guo Y, Gao L, Zeng T, Hou L, Zhao L, Zhu X, Lv S, Mou Z, Wu J, Xu Y, Dong B, Yang C, An Z, Wang X, Zhu X, Gu L, Ma C, Sun H, Li W, Huang X, Li L, Qiu B, Bao Y, Qian S, Bu X, Wang Y, Yang L, Fu X, Qian S, Zhang J, Fan S, Wang Y, Bao Y, Wang Y, Chen H, Cui G, Sun C, Guo Z, Li Y, Wang X, Zhou S, Wang X, Zhu X, Zheng G, Huang Q, Zhang Y, Feng H, Huang Y, Ren H, Hou B, Zhou C, Chen J, Hu J, Du Z, Wang S, Xiang P, Huang Y, Qu Y, Yu H, Wang R, Chen J, Chen J, Xu L, Kang P, Chen H, Wu G, Wang M, Li R, Zhang H, Li Y, Sun X, Tan X. Comparison of Care System and Treatment Approaches for Patients with Traumatic Brain Injury in China versus Europe: A CENTER-TBI Survey Study. J Neurotrauma 2020; 37:1806-1817. [PMID: 32174214 DOI: 10.1089/neu.2019.6900] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Junfeng Feng
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
- Shanghai Institute of Head Trauma, Shanghai, People's Republic of China
| | - Ernest van Veen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Chun Yang
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
- Shanghai Institute of Head Trauma, Shanghai, People's Republic of China
| | - Jilske A. Huijben
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hester F. Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Guoyi Gao
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
- Shanghai Institute of Head Trauma, Shanghai, People's Republic of China
| | - Jiyao Jiang
- Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
- Shanghai Institute of Head Trauma, Shanghai, People's Republic of China
| | - Andrew I.R. Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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Provencio JJ, Hemphill JC, Claassen J, Edlow BL, Helbok R, Vespa PM, Diringer MN, Polizzotto L, Shutter L, Suarez JI, Stevens RD, Hanley DF, Akbari Y, Bleck TP, Boly M, Foreman B, Giacino JT, Hartings JA, Human T, Kondziella D, Ling GSF, Mayer SA, McNett M, Menon DK, Meyfroidt G, Monti MM, Park S, Pouratian N, Puybasset L, Rohaut B, Rosenthal ES, Schiff ND, Sharshar T, Wagner A, Whyte J, Olson DM. The Curing Coma Campaign: Framing Initial Scientific Challenges-Proceedings of the First Curing Coma Campaign Scientific Advisory Council Meeting. Neurocrit Care 2020; 33:1-12. [PMID: 32578124 PMCID: PMC7392933 DOI: 10.1007/s12028-020-01028-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Coma and disordered consciousness are common manifestations of acute neurological conditions and are among the most pervasive and challenging aspects of treatment in neurocritical care. Gaps exist in patient assessment, outcome prognostication, and treatment directed specifically at improving consciousness and cognitive recovery. In 2019, the Neurocritical Care Society (NCS) launched the Curing Coma Campaign in order to address the "grand challenge" of improving the management of patients with coma and decreased consciousness. One of the first steps was to bring together a Scientific Advisory Council including coma scientists, neurointensivists, neurorehabilitationists, and implementation experts in order to address the current scientific landscape and begin to develop a framework on how to move forward. This manuscript describes the proceedings of the first Curing Coma Campaign Scientific Advisory Council meeting which occurred in conjunction with the NCS Annual Meeting in October 2019 in Vancouver. Specifically, three major pillars were identified which should be considered: endotyping of coma and disorders of consciousness, biomarkers, and proof-of-concept clinical trials. Each is summarized with regard to current approach, benefits to the patient, family, and clinicians, and next steps. Integration of these three pillars will be essential to the success of the Curing Coma Campaign as will expanding the "curing coma community" to ensure broad participation of clinicians, scientists, and patient advocates with the goal of identifying and implementing treatments to fundamentally improve the outcome of patients.
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Affiliation(s)
- J Javier Provencio
- Department of Neurology and Neuroscience, University of Virginia, Charlottesville, VA, USA
| | - J Claude Hemphill
- Department of Neurology, Zuckerberg San Francisco General Hospital, University of California, San Francisco, Building 1, Room 101, 1001 Potrero Avenue, San Francisco, CA, 94110, USA.
| | - Jan Claassen
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Brian L Edlow
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raimund Helbok
- Department of Neurology, Neurocritical Care, Medical University of Innsbruck, Innsbruck, Austria
| | - Paul M Vespa
- Departments of Neurology and Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael N Diringer
- Department of Neurology, Washington University, Barnes-Jewish Hospital, St Louis, MO, USA
| | - Len Polizzotto
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Lori Shutter
- Departments of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh/UPMC Health System, Pittsburgh, PA, USA
| | - Jose I Suarez
- Departments of Anesthesiology and Critical Care Medicine, Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert D Stevens
- Departments of Anesthesiology and Critical Care Medicine, Neurology and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University, Baltimore, MD, USA
| | - Yama Akbari
- Departments of Neurology, Neurosurgery and the Beckman Laser Institute, University of California-Irvine, Irvine, CA, USA
| | - Thomas P Bleck
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Melanie Boly
- Department of Neurology, University of Wisconsin-Madison, Madison, WI, USA
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati Gardner Neuroscience Institute, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Jed A Hartings
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Theresa Human
- Departments of Neurology and Neurosurgery, Washington University, Barnes-Jewish Hospital, St Louis, MO, USA
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Geoffrey S F Ling
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephan A Mayer
- Departments of Neurology and Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Molly McNett
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Geert Meyfroidt
- Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Martin M Monti
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Soojin Park
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Nader Pouratian
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Louis Puybasset
- Department of Anesthesiology and Critical Care, Sorbonne University, GRC 29, AP-HP, DMU DREAM, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Benjamin Rohaut
- Department of Neurology, Neuro-ICU, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Eric S Rosenthal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas D Schiff
- Departments of Neurology, Neuroscience, and Medical Ethics, Weill Cornell Medicine, New York, NY, USA
| | - Tarek Sharshar
- Neuro-anesthesiology and Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris, France
- Experimental Neuropathology, Infection and Epidemiology Department, Institut Pasteur, Paris, France
| | - Amy Wagner
- Department of Physical Medicine and Rehabilitation, Department of Neuroscience, Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - John Whyte
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - DaiWai M Olson
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern, Dallas, TX, USA
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30
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Hermann B, Salah AB, Perlbarg V, Valente M, Pyatigorskaya N, Habert MO, Raimondo F, Stender J, Galanaud D, Kas A, Puybasset L, Perez P, Sitt JD, Rohaut B, Naccache L. Habituation of auditory startle reflex is a new sign of minimally conscious state. Brain 2020; 143:2154-2172. [PMID: 32582938 PMCID: PMC7364741 DOI: 10.1093/brain/awaa159] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/05/2020] [Accepted: 03/30/2020] [Indexed: 02/07/2023] Open
Abstract
Neurological examination of non-communicating patients relies on a few decisive items that enable the crucial distinction between vegetative state (VS)-also coined unresponsive wakefulness syndrome (UWS)-and minimally conscious state. Over the past 10 years, this distinction has proven its diagnostic value as well as its important prognostic value on consciousness recovery. However, clinicians are currently limited by three factors: (i) the current behavioural repertoire of minimally conscious state items is limited and restricted to a few cognitive domains in the goldstandard revised version of the Coma Recovery Scale; (ii) a proportion of ∼15-20% clinically VS/UWS patients are actually in a richer state than VS/UWS as evidenced by functional brain imaging; and (iii) the neurophysiological and cognitive interpretation of each minimally conscious state item is still unclear and debated. In the current study we demonstrate that habituation of the auditory startle reflex (hASR) tested at bedside constitutes a novel, simple and powerful behavioural sign that can accurately distinguish minimally conscious state from VS/UWS. In addition to enlarging the minimally conscious state items repertoire, and therefore decreasing the low sensitivity of current behavioural measures, we also provide an original and rigorous description of the neurophysiological basis of hASR through a combination of functional (high density EEG and 18F-fluorodeoxyglucose PET imaging) and structural (diffusion tensor imaging MRI) measures. We show that preservation of hASR is associated with the functional and structural integrity of a brain-scale fronto-parietal network, including prefrontal regions related to control of action and inhibition, and meso-parietal areas associated with minimally conscious and conscious states. Lastly, we show that hASR predicts 6-month improvement of consciousness. Taken together, our results show that hASR is a cortically-mediated behaviour, and suggest that it could be a new clinical item to clearly and accurately identify non-communicating patients who are in the minimally conscious state.
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Affiliation(s)
- Bertrand Hermann
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Department of Neurology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
- Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
| | - Amina Ben Salah
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
| | - Vincent Perlbarg
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, LIB, F-75006, Paris, France
- BrainTale SAS, F-75013, Paris, France
| | - Mélanie Valente
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Department of Clinical Neurophysiology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Nadya Pyatigorskaya
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
- Department of Neuroradiology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Marie-Odile Habert
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, LIB, F-75006, Paris, France
- Department of Nuclear Medicine, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Federico Raimondo
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Coma Science Group, GIGA Consciousness, University of Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Belgium
| | - Johan Stender
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
| | - Damien Galanaud
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
- Department of Neuroradiology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Aurélie Kas
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, LIB, F-75006, Paris, France
- Department of Nuclear Medicine, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Louis Puybasset
- Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
- Sorbonne Université, CNRS, INSERM, Laboratoire d’Imagerie Biomédicale, LIB, F-75006, Paris, France
- Department of Anesthesia and Critical Care, Multidisciplinary Intensive Care Unit, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
| | - Pauline Perez
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
| | - Jacobo D Sitt
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
| | - Benjamin Rohaut
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Department of Neurology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
- Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
- Department of Neurology, Columbia University, New York, NY 10027, USA
| | - Lionel Naccache
- Institut du Cerveau et de la Moelle épinière - ICM, Inserm U1127, CNRS UMR 7225, F-75013, Paris, France
- Department of Neurology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
- Faculté de Médecine Pitié-Salpêtrière, Sorbonne Universités, UPMC Université Paris 06, Paris, France
- Department of Clinical Neurophysiology, Groupe hospitalier Pitié-Salpêtrière, AP-HP, F-75013, Paris, France
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31
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Pulcrano-Nicolas AS, Jacquens A, Proust C, Clarençon F, Perret C, Shotar E, Puybasset L, Le Goff W, Degos V, Trégouët DA, Garnier S. Whole blood levels of S1PR4 mRNA associated with cerebral vasospasm after aneurysmal subarachnoid hemorrhage. J Neurosurg 2019:1-5. [PMID: 31783362 DOI: 10.3171/2019.9.jns191305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 09/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors sought to identify mRNA biomarkers of cerebral vasospasm in whole blood of patients suffering from aneurysmal subarachnoid hemorrhage (aSAH). METHODS A prospective transcriptomic study for vasospasm was conducted in whole blood samples of 44 aSAH patients who developed (VSP+ group, n = 22) or did not develop (VSP- group, n = 22) vasospasm. Samples from all patients were profiled for 21,460 mRNA probes using the Illumina Human HT12v4.0 array. Differential statistical analysis was performed using a linear mixed model. RESULTS Levels of sphingosine-1-phosphate receptor 4 (S1PR4) mRNA were significantly higher (p = 8.03 × 10-6) at presentation in patients who developed vasospasm after aSAH than in patients who did not. CONCLUSIONS The results, which are consistent with findings of previous experimental investigations conducted in animal models, support the role of S1PR4 and its ligand, sphingosine-1-phosphate (S1P), in arterial-associated vasoconstriction, which suggests that S1PR4 could be used as a biomarker for cerebral vasospasm in aSAH patients.
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Affiliation(s)
- Anne-Sophie Pulcrano-Nicolas
- 1Sorbonne Université, UPMC, INSERM UMR_S 1166, F-75013, Paris
- 2ICAN Institute for Cardiometabolism and Nutrition, Paris
| | - Alice Jacquens
- 3Department of Anesthesia and Intensive Care, Pitié-Salpetrière Hospital, Assistance, Publique-Hopitaux de Paris, Paris
- 4Université Paris 7, INSERM UMR 1141, Paris
| | - Carole Proust
- 5INSERM UMR_S 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux
| | - Frédéric Clarençon
- 6Sorbonne Université, UPMC, Groupe de Recherche Clinique Biosfast, Paris; and
- 7Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Claire Perret
- 1Sorbonne Université, UPMC, INSERM UMR_S 1166, F-75013, Paris
- 2ICAN Institute for Cardiometabolism and Nutrition, Paris
| | - Eimad Shotar
- 7Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Louis Puybasset
- 3Department of Anesthesia and Intensive Care, Pitié-Salpetrière Hospital, Assistance, Publique-Hopitaux de Paris, Paris
- 4Université Paris 7, INSERM UMR 1141, Paris
| | - Wilfried Le Goff
- 1Sorbonne Université, UPMC, INSERM UMR_S 1166, F-75013, Paris
- 2ICAN Institute for Cardiometabolism and Nutrition, Paris
| | - Vincent Degos
- 3Department of Anesthesia and Intensive Care, Pitié-Salpetrière Hospital, Assistance, Publique-Hopitaux de Paris, Paris
- 4Université Paris 7, INSERM UMR 1141, Paris
| | - David-Alexandre Trégouët
- 5INSERM UMR_S 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux
| | - Sophie Garnier
- 1Sorbonne Université, UPMC, INSERM UMR_S 1166, F-75013, Paris
- 2ICAN Institute for Cardiometabolism and Nutrition, Paris
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32
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Pulcrano-Nicolas AS, Proust C, Clarençon F, Jacquens A, Perret C, Roux M, Shotar E, Thibord F, Puybasset L, Garnier S, Degos V, Trégouët DA. Whole-Blood miRNA Sequencing Profiling for Vasospasm in Patients With Aneurysmal Subarachnoid Hemorrhage. Stroke 2019; 49:2220-2223. [PMID: 30354977 DOI: 10.1161/strokeaha.118.021101] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background and Purpose- Arterial vasospasm is a well-known delayed complication of aneurysmal subarachnoid hemorrhage (aSAH). However, no validated biomarker exists to help clinicians discriminating patients with aSAH who will develop vasospasm (VSP+) and identifying those who then deserve aggressive preventive therapy. We hypothesized that whole-blood miRNAs could be a source of candidate biomarkers for vasospasm. Methods- Using a next-generation sequencing approach, we performed whole-blood miRNA profiling between VSP+patients with aSAH and patients who did not develop vasospasm (VSP-) in a prospective cohort of 32 patients. Profiling was performed on the admission day and 3 days before vasospasm. Results- Four hundred forty-two miRNAs were highly expressed in whole blood of patients with aSAH. Among them, hsa-miR-3177-3p demonstrated significant ( P=5.9×10-5; PBonferroni corrected=0.03) lower levels in VSP- compared with VSP+ patients. Looking for whole-blood mRNA correlates of hsa-miR-3177-3p, we observed some evidence that the decrease in hsa-miR-3177-3p levels after aSAH was associated with an increase in LDHA mRNA levels in VSP- ( P<10-3) but not in VSP+ ( P=0.66) patients. Conclusions- Whole-blood miRNA levels of hsa-miR-3177-3p could serve as a biomarker for vasospasm. Clinical Trial Registration- URL: https://www.clinicaltrials.gov . Unique identifier: NCT01779713.
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Affiliation(s)
- Anne-Sophie Pulcrano-Nicolas
- From the INSERM UMR-S 1166 (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.).,Sorbonne Universités, University Pierre et Marie Curie, Université Paris 06, France; ICAN Institute of Cardiometabolism and Nutrition, Paris, France (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.)
| | - Carole Proust
- From the INSERM UMR-S 1166 (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.).,Sorbonne Universités, University Pierre et Marie Curie, Université Paris 06, France; ICAN Institute of Cardiometabolism and Nutrition, Paris, France (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.)
| | - Frédéric Clarençon
- Groupe de Recherche Clinique Biosfast (F.C., E.S.).,Department of Neuroradiology (F.C., E.S.)
| | - Alice Jacquens
- Department of Anesthesia and Intensive Care (A.J., L.P., V.D.).,Pitié-Salpetrière Hospital, Assistance Publique-Hopitaux de Paris, France; and INSERM UMR 1141, Université Paris 7, France (A.J., L.P., V.D.)
| | - Claire Perret
- From the INSERM UMR-S 1166 (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.).,Sorbonne Universités, University Pierre et Marie Curie, Université Paris 06, France; ICAN Institute of Cardiometabolism and Nutrition, Paris, France (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.)
| | - Maguelonne Roux
- From the INSERM UMR-S 1166 (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.).,Sorbonne Universités, University Pierre et Marie Curie, Université Paris 06, France; ICAN Institute of Cardiometabolism and Nutrition, Paris, France (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.)
| | - Eimad Shotar
- Groupe de Recherche Clinique Biosfast (F.C., E.S.).,Department of Neuroradiology (F.C., E.S.)
| | - Florian Thibord
- From the INSERM UMR-S 1166 (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.).,Sorbonne Universités, University Pierre et Marie Curie, Université Paris 06, France; ICAN Institute of Cardiometabolism and Nutrition, Paris, France (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.)
| | - Louis Puybasset
- Department of Anesthesia and Intensive Care (A.J., L.P., V.D.).,Pitié-Salpetrière Hospital, Assistance Publique-Hopitaux de Paris, France; and INSERM UMR 1141, Université Paris 7, France (A.J., L.P., V.D.)
| | - Sophie Garnier
- From the INSERM UMR-S 1166 (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.).,Sorbonne Universités, University Pierre et Marie Curie, Université Paris 06, France; ICAN Institute of Cardiometabolism and Nutrition, Paris, France (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.)
| | - Vincent Degos
- Department of Anesthesia and Intensive Care (A.J., L.P., V.D.).,Pitié-Salpetrière Hospital, Assistance Publique-Hopitaux de Paris, France; and INSERM UMR 1141, Université Paris 7, France (A.J., L.P., V.D.)
| | - David-Alexandre Trégouët
- From the INSERM UMR-S 1166 (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.).,Sorbonne Universités, University Pierre et Marie Curie, Université Paris 06, France; ICAN Institute of Cardiometabolism and Nutrition, Paris, France (A.-S.P.-N., C. Proust, C. Perret, M.R., F.T., S.G., D.-A.T.)
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Lesimple B, Caron E, Lefort M, Debarle C, Pélégrini-Issac M, Cassereau D, Delphine S, Torkomian G, Battisti V, Bossale P, Galanaud D, Puybasset L, Pradat-Diehl P, Perlbarg V. Long-term cognitive disability after traumatic brain injury: Contribution of the DEX relative questionnaires. Neuropsychol Rehabil 2019; 30:1905-1924. [PMID: 31116085 DOI: 10.1080/09602011.2019.1618345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Executive functions are high-level cognitive processes commonly impaired after severe traumatic brain injury (sTBI), which may be associated with persistent anosognosia. The dysexecutive questionnaire (DEX) was designed to assess different domains of executive functioning in daily life. Two versions of the DEX exist (DEX-S completed by the patient, DEX-O completed by a relative) to compare cognitive complaints and patient's awareness. This work was aimed at studying the relevance of DEX-O for assessing daily-life limitations, the persistence of anosognosia and its association with global disability (GOSE) and magnetic resonance imaging (MRI) markers of brain alterations. Sixty-three patients (and relatives) were included within 63.4 months (±20.7) after sTBI. DEX-S and DEX-O scores were significantly positively correlated. We obtained significant correlations between DEX-S and episodic memory and phasic alert but not with executive assessment, GOSE and diffusion MRI markers. DEX-O was significantly correlated with executive function, episodic memory, attention (phasic alert sustained and divided attention), with the GOSE and the volume of the body of the corpus callosum (MRI marker). Anosognosia score (DEX-O minus DEX-S) correlated with mean diffusivity measure. These results highlight the clinical interest of DEX-O in assessing long-term disability.
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Affiliation(s)
- Blandine Lesimple
- AP-HP, Service de Neuroréanimation chirurgicale, Hôpital Pitié-Salpêtrière, Paris, France.,SAMSAH La Note Bleue, Fondation Partage et Vie, Paris, France
| | - Elsa Caron
- AP-HP, Service de Médecine Physique et Réadaptation, Hôpital Pitié-Salpêtrière, Paris, France.,dSAMSAH -SAVS, Association Guyanaise contre les Maladies Neuromusculaires, Cayenne, France
| | - Muriel Lefort
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Clara Debarle
- GRC-Sorbonne Université n°18 HanCRe, Sorbonne Université, Paris, France
| | | | - Didier Cassereau
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France.,ESPCI ParisTech, PSL Research University, Paris, France
| | - Sébastien Delphine
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France.,Institut des Neurosciences Translationnelles de Paris, IHU-A-ICM, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Grégory Torkomian
- AP-HP, Service de Neuroréanimation chirurgicale, Hôpital Pitié-Salpêtrière, Paris, France
| | - Valentine Battisti
- AP-HP, Service de Neuroréanimation chirurgicale, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pierrette Bossale
- AP-HP, Service de Neuroréanimation chirurgicale, Hôpital Pitié-Salpêtrière, Paris, France
| | - Damien Galanaud
- AP-HP, Service de Neuroradiologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Louis Puybasset
- AP-HP, Service de Neuroréanimation chirurgicale, Hôpital Pitié-Salpêtrière, Paris, France.,Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France
| | - Pascale Pradat-Diehl
- AP-HP, Service de Médecine Physique et Réadaptation, Hôpital Pitié-Salpêtrière, Paris, France.,Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France.,GRC-Sorbonne Université n°18 HanCRe, Sorbonne Université, Paris, France
| | - Vincent Perlbarg
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, LIB, Paris, France.,Bioinformatics and Biostatistics Core Facility, iCONICS, ICM, Institut du Cerveau et de la Moelle épinière, Paris, France
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34
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Oddo M, Bracard S, Cariou A, Chanques G, Citerio G, Clerckx B, Godeau B, Godier A, Horn J, Jaber S, Jung B, Kuteifan K, Leone M, Mailles A, Mazighi M, Mégarbane B, Outin H, Puybasset L, Sharshar T, Sandroni C, Sonneville R, Weiss N, Taccone FS. Update in Neurocritical Care: a summary of the 2018 Paris international conference of the French Society of Intensive Care. Ann Intensive Care 2019; 9:47. [PMID: 30993550 PMCID: PMC6468018 DOI: 10.1186/s13613-019-0523-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/08/2019] [Indexed: 02/08/2023] Open
Abstract
The 2018 Paris Intensive Care symposium entitled "Update in Neurocritical Care" was organized in Paris, June 21-22, 2018, under the auspices of the French Intensive Care Society. This 2-day post-graduate educational symposium comprised several chapters, aiming first to provide all-board intensivists with current standards for the clinical assessment of altered consciousness states (including coma and delirium) and peripheral nervous system in critically ill patients, monitoring of brain function (specifically, electro-encephalography) and best practices for sedation-analgesia-delirium management. An update on the treatment of specific severe brain pathologies-including ischaemic/haemorrhagic stroke, cerebral venous thrombosis, hypoxic-ischaemic brain injury, immune-mediated and infectious encephalitis and refractory status epilepticus-was also provided. Finally, we discuss how to approach some difficult decisions, namely the role of decompressive craniectomy and prognostication models in patients with head injury. For each chapter, the scope of the present review was to provide important issues and key messages, provide most recent and relevant literature in the field, and briefly describe new developments in the field.
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Affiliation(s)
- Mauro Oddo
- Department of Intensive Care Medicine, CHUV-Lausanne University Hospital, Lausanne, Switzerland
| | - Serge Bracard
- Department of Diagnostic and Interventional Neuroradiology, University of Lorraine and University Hospital of Nancy, Nancy, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, Université Paris Descartes, Paris, France
| | - Gérald Chanques
- Department of Anaesthesia and Intensive Care, Montpellier Saint Eloi University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, 34295, Montpellier Cedex 5, France
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Béatrix Clerckx
- Department of Intensive Care Medicine, University Hospitals Leuven, Louvain, Belgium
| | - Bertrand Godeau
- Service de Médecine Interne, Centre de Référence des Cytopénies Auto-Immunes de l'Adulte, Hôpital Henri-Mondor, Créteil, France
| | - Anne Godier
- Fondation Adolphe de Rothschild, Department of Anesthesiology and Intensive Care, Paris Descartes University, Paris, France
| | - Janneke Horn
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Samir Jaber
- Department of Anaesthesia and Intensive Care, Montpellier Saint Eloi University Hospital, and PhyMedExp, University of Montpellier, INSERM, CNRS, 34295, Montpellier Cedex 5, France
| | - Boris Jung
- Medical Intensive Care Unit, Montpellier Teaching Hospital, PhyMedex, University of Montpellier, Montpellier, France
| | | | - Marc Leone
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Alexandra Mailles
- ESGIB, ESCMID Study Group for Infectious Diseases of the Brain, Santé Publique France, 12, rue du Val-d'Osne, 94415, Saint-Maurice Cedex, France
| | - Mikael Mazighi
- Department of Diagnostic and Interventional Neuroradiology, Rothschild Foundation, Paris, France
| | - Bruno Mégarbane
- Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris, France
| | - Hervé Outin
- Service de Réanimation Médico-Chirurgicale, CHI de Poissy-Saint Germain en Laye, Poissy, France
| | - Louis Puybasset
- Department of Anesthesia and Intensive Care, Pitié-Salpetrière Hospital, Paris, France
| | - Tarek Sharshar
- Medical and Surgical Neurointensive Care Centre, Hospital Sainte Anne, Paris, France
| | - Claudio Sandroni
- Istituto Anestesiologia e Rianimazione Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Romain Sonneville
- Department of Intensive Care Medicine and Infectious Diseases, Hôpital Bichat-Claude, Université Paris Diderot, Paris, France
| | - Nicolas Weiss
- Neurocritical Care Unit, Department of Neurology, Assistance Publique - Hôpitaux de Paris, La Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik, 808, 1070, Brussels, Belgium.
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Eyraud D, Granger B, Bardier A, Loncar Y, Gottrand G, Le Naour G, Siksik JM, Vaillant JC, Klatzmann D, Puybasset L, Charlotte F, Augustin J. Immunological environment in colorectal cancer: a computer-aided morphometric study of whole slide digital images derived from tissue microarray. Pathology 2018; 50:607-612. [PMID: 30166125 DOI: 10.1016/j.pathol.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/10/2018] [Accepted: 04/20/2018] [Indexed: 12/13/2022]
Abstract
Cancer research has moved from investigating tumour cells to including analysis of the tumour microenvironment as well. The aim of this study was to assess the cellular infiltrate of colorectal cancer (CRC) using computer-aided analysis of whole slide digital image derived from tissue microarray (TMA). TMA slides from 31 CRC patients were immunostained for forkhead box protein 3 (FOXP3) and immunomodulatory enzyme indoleamine 2,3-dioxygenase (IDO) at four sites: centre (C) and invasive front (F) of the tumour, proximal non-metastatic draining lymph node (N-), tumour-draining lymph node with metastasis (N+) and healthy mucosa at 10 cm from the cancer (M). We analysed the proportion of IDO+ tissue areas in the lamina propria or in the non-epithelial area of the lymph node and in epithelial cells in each site. The normal mucosa of patients operated on for benign disease was also analysed. The proportion (%) of FOXP3+ tissue area in C, F, N-, N+ and M were 2.3 ± 1.8, 2.6 ± 2.9, 6.0 ± 2.9, 14.2 ± 5.8 and 1.2 ± 0.8 (p < 0.001). The proportion (%) of IDO+ tissue area in the lamina propria of C, F, N-, N+ and M were 1.6 ± 3.1, 1.1 ± 1.3, 3.4 ± 2.5, 9.1 ± 8.5 and 6.7 ± 5.4 (p < 0.001). IDO+ tissue area in the lamina propria was not significantly different between healthy mucosa of patients with cancer than without (1.8 ± 3 vs 1.1 ± 0.95). The proportion of IDO positive tissue area in the epithelium was significantly higher in healthy mucosa of patients with cancer than without (5.4 ± 13.8 vs 2.1 ± 2.4). The FOXP3+ tissue area was increased in healthy mucosa of CRC patients in comparison with healthy mucosa of patients with colorectal resection for disease other than cancer: 1.20 ± 1.81 versus 0.81 ± 0.51 (p < 0.05). The proportion of IDO+ tissue area in lymph node (N-) was correlated with the proportion of FOXP3+ tissue area in tumour area (r = 0.44, p < 0.01). TMA technique permits simultaneous analysis of FOXP3+ and IDO+ cells at different sites including tumour, draining non-metastatic lymph node, metastatic lymph node and normal mucosa.
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Affiliation(s)
- Daniel Eyraud
- Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Paris, France; Service d'Anatomie Pathologique, UIMAP, Hôpital Pitié-Salpêtrière, Paris, France; Service de Biothérapies, UPMC, CNRS 7211, INSERM 959, Hôpital Pitié-Salpêtrière, Paris, France.
| | - Benjamin Granger
- Département de Biostatistiques, de Santé Publique et d'Information Médicale, Hôpital Pitié-Salpêtrière, Paris, France
| | - Armelle Bardier
- Service d'Anatomie Pathologique, UIMAP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Yann Loncar
- Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Paris, France
| | - GaËlle Gottrand
- Service de Biothérapies, UPMC, CNRS 7211, INSERM 959, Hôpital Pitié-Salpêtrière, Paris, France
| | - Gilles Le Naour
- Service d'Anatomie Pathologique, UIMAP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Michel Siksik
- Service de Chirurgie Digestive et de Transplantation Hépatique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jean-Christophe Vaillant
- Service de Chirurgie Digestive et de Transplantation Hépatique, Hôpital Pitié-Salpêtrière, Paris, France
| | - David Klatzmann
- Service de Biothérapies, UPMC, CNRS 7211, INSERM 959, Hôpital Pitié-Salpêtrière, Paris, France
| | - Louis Puybasset
- Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpêtrière, Paris, France
| | - Frederic Charlotte
- Service d'Anatomie Pathologique, UIMAP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Jeremy Augustin
- Service d'Anatomie Pathologique, UIMAP, Hôpital Pitié-Salpêtrière, Paris, France
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Eyraud D, Suner L, Dupont A, Bachelot-Loza C, Smadja DM, Helley D, Bertil S, Gostian O, Szymezak J, Loncar Y, Puybasset L, Lebray P, Vezinet C, Vaillant JC, Granger B, Gaussem P. Evolution of platelet functions in cirrhotic patients undergoing liver transplantation: A prospective exploration over a month. PLoS One 2018; 13:e0200364. [PMID: 30071043 PMCID: PMC6072007 DOI: 10.1371/journal.pone.0200364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/25/2018] [Indexed: 12/23/2022] Open
Abstract
This prospective observational study was designed to analyze platelet functions across time in 50 patients scheduled for liver transplantation (LT) secondary to decompensated cirrhosis or hepatocellular carcinoma. Platelet functions were assessed before LT (pre-LT), one week (D7) and 1 month (D28) after LT. Platelet count significantly increased from pre-LT time to day 28 as well as circulating CD34+hematopoietic stem cells. To avoid any influence of platelet count on assays, platelet function was evaluated on platelet-rich-plasma adjusted to pre-LT platelet count. Although platelet secretion potential did not differ between time-points, as evaluated by the expression of CD62P upon strong activation, platelet aggregation in response to various agonists significantly increased along time, however with no concomitant increase of circulating markers of platelet activation: platelet microvesicles, platelet-leukocyte complexes, soluble CD40L and soluble CD62P. In the multivariate analysis, hepatic function was associated with platelet count and function. A lower platelet aggregation recovery was correlated with Child C score. History of thrombosis or bleeding was associated with respective higher or lower values of platelet aggregation. This longitudinal analysis of platelet functions in LT patients showed an improvement of platelet functions along time together with platelet count increase, with no evidence of platelet hyperactivation at any time-point.
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Affiliation(s)
- Daniel Eyraud
- AP-HP, Pitié-Salpêtrière University Hospital, Department of Anesthesiology and Reanimation, Paris, France
- AP-HP, Pitié-Salpêtrière University Hospital, Department of Digestive, HPB Surgery, and Liver Transplantation, Paris, France
- Université Pierre et Marie Curie, Paris, France
| | - Ludovic Suner
- AP-HP, European University Hospital Georges Pompidou, Hematology Department, Paris, France
| | - Axelle Dupont
- Université Pierre et Marie Curie, Paris, France
- AP-HP, Pitié-Salpêtrière University Hospital, Department of statistics, Clinical Research Unit, Paris, France
| | - Christilla Bachelot-Loza
- Inserm UMR-S1140, Faculté de Pharmacie, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - David M. Smadja
- AP-HP, European University Hospital Georges Pompidou, Hematology Department, Paris, France
- Inserm UMR-S1140, Faculté de Pharmacie, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Dominique Helley
- AP-HP, European University Hospital Georges Pompidou, Hematology Department, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Inserm UMR-S970, Paris, France
| | - Sébastien Bertil
- AP-HP, European University Hospital Georges Pompidou, Hematology Department, Paris, France
| | - Ovidiu Gostian
- AP-HP, Pitié-Salpêtrière University Hospital, Department of Anesthesiology and Reanimation, Paris, France
- Université Pierre et Marie Curie, Paris, France
| | - Jean Szymezak
- AP-HP, European University Hospital Georges Pompidou, Hematology Department, Paris, France
| | - Yann Loncar
- AP-HP, Pitié-Salpêtrière University Hospital, Department of Anesthesiology and Reanimation, Paris, France
- Université Pierre et Marie Curie, Paris, France
| | - Louis Puybasset
- AP-HP, Pitié-Salpêtrière University Hospital, Department of Anesthesiology and Reanimation, Paris, France
- Université Pierre et Marie Curie, Paris, France
| | - Pascal Lebray
- AP-HP, Pitié-Salpêtrière University Hospital, Hepatology Department, Paris, France
| | - Corinne Vezinet
- AP-HP, Pitié-Salpêtrière University Hospital, Department of Anesthesiology and Reanimation, Paris, France
| | - Jean-Christophe Vaillant
- AP-HP, Pitié-Salpêtrière University Hospital, Department of Digestive, HPB Surgery, and Liver Transplantation, Paris, France
- Université Pierre et Marie Curie, Paris, France
| | - Benjamin Granger
- Université Pierre et Marie Curie, Paris, France
- AP-HP, Pitié-Salpêtrière University Hospital, Department of statistics, Clinical Research Unit, Paris, France
| | - Pascale Gaussem
- AP-HP, European University Hospital Georges Pompidou, Hematology Department, Paris, France
- Inserm UMR-S1140, Faculté de Pharmacie, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Caron E, Lesimple B, Debarle C, Lefort M, Galanaud D, Perlbarg V, Puybasset L, Pradat-Diehl P. Neuropsychological assessment of a long-term (LT) outcome after severe traumatic brain injury (TBI). Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Velly L, Perlbarg V, Boulier T, Adam N, Delphine S, Luyt CE, Battisti V, Torkomian G, Arbelot C, Chabanne R, Jean B, Di Perri C, Laureys S, Citerio G, Vargiolu A, Rohaut B, Bruder N, Girard N, Silva S, Cottenceau V, Tourdias T, Coulon O, Riou B, Naccache L, Gupta R, Benali H, Galanaud D, Puybasset L, Constantin JM, Chastre J, Amour J, Vezinet C, Rouby JJ, Raux M, Langeron O, Degos V, Bolgert F, Weiss N, Similowski T, Demoule A, Duguet A, Tollard E, Veber B, Lotterie JA, SANCHEZ-PENA P, Génestal M, Patassini M. Use of brain diffusion tensor imaging for the prediction of long-term neurological outcomes in patients after cardiac arrest: a multicentre, international, prospective, observational, cohort study. Lancet Neurol 2018; 17:317-326. [DOI: 10.1016/s1474-4422(18)30027-9] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 01/19/2023]
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Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, Bragge P, Brazinova A, Büki A, Chesnut RM, Citerio G, Coburn M, Cooper DJ, Crowder AT, Czeiter E, Czosnyka M, Diaz-Arrastia R, Dreier JP, Duhaime AC, Ercole A, van Essen TA, Feigin VL, Gao G, Giacino J, Gonzalez-Lara LE, Gruen RL, Gupta D, Hartings JA, Hill S, Jiang JY, Ketharanathan N, Kompanje EJO, Lanyon L, Laureys S, Lecky F, Levin H, Lingsma HF, Maegele M, Majdan M, Manley G, Marsteller J, Mascia L, McFadyen C, Mondello S, Newcombe V, Palotie A, Parizel PM, Peul W, Piercy J, Polinder S, Puybasset L, Rasmussen TE, Rossaint R, Smielewski P, Söderberg J, Stanworth SJ, Stein MB, von Steinbüchel N, Stewart W, Steyerberg EW, Stocchetti N, Synnot A, Te Ao B, Tenovuo O, Theadom A, Tibboel D, Videtta W, Wang KKW, Williams WH, Wilson L, Yaffe K, Adams H, Agnoletti V, Allanson J, Amrein K, Andaluz N, Anke A, Antoni A, van As AB, Audibert G, Azaševac A, Azouvi P, Azzolini ML, Baciu C, Badenes R, Barlow KM, Bartels R, Bauerfeind U, Beauchamp M, Beer D, Beer R, Belda FJ, Bellander BM, Bellier R, Benali H, Benard T, Beqiri V, Beretta L, Bernard F, Bertolini G, Bilotta F, Blaabjerg M, den Boogert H, Boutis K, Bouzat P, Brooks B, Brorsson C, Bullinger M, Burns E, Calappi E, Cameron P, Carise E, Castaño-León AM, Causin F, Chevallard G, Chieregato A, Christie B, Cnossen M, Coles J, Collett J, Della Corte F, Craig W, Csato G, Csomos A, Curry N, Dahyot-Fizelier C, Dawes H, DeMatteo C, Depreitere B, Dewey D, van Dijck J, Đilvesi Đ, Dippel D, Dizdarevic K, Donoghue E, Duek O, Dulière GL, Dzeko A, Eapen G, Emery CA, English S, Esser P, Ezer E, Fabricius M, Feng J, Fergusson D, Figaji A, Fleming J, Foks K, Francony G, Freedman S, Freo U, Frisvold SK, Gagnon I, Galanaud D, Gantner D, Giraud B, Glocker B, Golubovic J, Gómez López PA, Gordon WA, Gradisek P, Gravel J, Griesdale D, Grossi F, Haagsma JA, Håberg AK, Haitsma I, Van Hecke W, Helbok R, Helseth E, van Heugten C, Hoedemaekers C, Höfer S, Horton L, Hui J, Huijben JA, Hutchinson PJ, Jacobs B, van der Jagt M, Jankowski S, Janssens K, Jelaca B, Jones KM, Kamnitsas K, Kaps R, Karan M, Katila A, Kaukonen KM, De Keyser V, Kivisaari R, Kolias AG, Kolumbán B, Kolundžija K, Kondziella D, Koskinen LO, Kovács N, Kramer A, Kutsogiannis D, Kyprianou T, Lagares A, Lamontagne F, Latini R, Lauzier F, Lazar I, Ledig C, Lefering R, Legrand V, Levi L, Lightfoot R, Lozano A, MacDonald S, Major S, Manara A, Manhes P, Maréchal H, Martino C, Masala A, Masson S, Mattern J, McFadyen B, McMahon C, Meade M, Melegh B, Menovsky T, Moore L, Morgado Correia M, Morganti-Kossmann MC, Muehlan H, Mukherjee P, Murray L, van der Naalt J, Negru A, Nelson D, Nieboer D, Noirhomme Q, Nyirádi J, Oddo M, Okonkwo DO, Oldenbeuving AW, Ortolano F, Osmond M, Payen JF, Perlbarg V, Persona P, Pichon N, Piippo-Karjalainen A, Pili-Floury S, Pirinen M, Ple H, Poca MA, Posti J, Van Praag D, Ptito A, Radoi A, Ragauskas A, Raj R, Real RGL, Reed N, Rhodes J, Robertson C, Rocka S, Røe C, Røise O, Roks G, Rosand J, Rosenfeld JV, Rosenlund C, Rosenthal G, Rossi S, Rueckert D, de Ruiter GCW, Sacchi M, Sahakian BJ, Sahuquillo J, Sakowitz O, Salvato G, Sánchez-Porras R, Sándor J, Sangha G, Schäfer N, Schmidt S, Schneider KJ, Schnyer D, Schöhl H, Schoonman GG, Schou RF, Sir Ö, Skandsen T, Smeets D, Sorinola A, Stamatakis E, Stevanovic A, Stevens RD, Sundström N, Taccone FS, Takala R, Tanskanen P, Taylor MS, Telgmann R, Temkin N, Teodorani G, Thomas M, Tolias CM, Trapani T, Turgeon A, Vajkoczy P, Valadka AB, Valeinis E, Vallance S, Vámos Z, Vargiolu A, Vega E, Verheyden J, Vik A, Vilcinis R, Vleggeert-Lankamp C, Vogt L, Volovici V, Voormolen DC, Vulekovic P, Vande Vyvere T, Van Waesberghe J, Wessels L, Wildschut E, Williams G, Winkler MKL, Wolf S, Wood G, Xirouchaki N, Younsi A, Zaaroor M, Zelinkova V, Zemek R, Zumbo F. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol 2017; 16:987-1048. [DOI: 10.1016/s1474-4422(17)30371-x] [Citation(s) in RCA: 822] [Impact Index Per Article: 117.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/06/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022]
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Faugeras F, Rohaut B, Valente M, Sitt J, Demeret S, Bolgert F, Weiss N, Grinea A, Marois C, Quirins M, Demertzi A, Raimondo F, Galanaud D, Habert MO, Engemann D, Puybasset L, Naccache L. Survival and consciousness recovery are better in the minimally conscious state than in the vegetative state. Brain Inj 2017; 32:72-77. [PMID: 29156989 DOI: 10.1080/02699052.2017.1364421] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The prognosis value of early clinical diagnosis of consciousness impairment is documented by an extremely limited number of studies, whereas it may convey important information to guide medical decisions. OBJECTIVE We aimed at determining if patients diagnosed at an early stage (<90 days after brain injury) as being in the minimally conscious state (MCS) have a better prognosis than patients in the vegetative state/Unresponsive Wakefulness syndrome (VS/UWS), independent of care limitations or withdrawal decisions. METHODS Patients hospitalized in ICUs of the Pitié-Salpêtrière Hospital (Paris, France) from November 2008 to January 2011 were included and evaluated behaviourally with standardized assessment and with the Coma Recovery Scale-Revised as being either in the VS/UWS or in the MCS. They were then prospectively followed until 1July 2011 to evaluate their outcome with the GOSE. We compared survival function and outcomes of these two groups. RESULTS Both survival function and outcomes, including consciousness recovery, were significantly better in the MCS group. This difference of outcome still holds when considering only patients still alive at the end of the study. CONCLUSIONS Early accurate clinical diagnosis of VS/UWS or MCS conveys a strong prognostic value of survival and of consciousness recovery.
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Affiliation(s)
- Frédéric Faugeras
- a AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurology , Paris , France.,b AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurophysiology , Paris , France.,c INSERM, U 1127 , Paris , France.,d Institut du Cerveau et de la Moelle épinière, ICM , PICNIC Lab , Paris , France
| | - Benjamin Rohaut
- a AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurology , Paris , France.,b AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurophysiology , Paris , France.,c INSERM, U 1127 , Paris , France.,d Institut du Cerveau et de la Moelle épinière, ICM , PICNIC Lab , Paris , France
| | - Mélanie Valente
- c INSERM, U 1127 , Paris , France.,d Institut du Cerveau et de la Moelle épinière, ICM , PICNIC Lab , Paris , France
| | - Jacobo Sitt
- c INSERM, U 1127 , Paris , France.,d Institut du Cerveau et de la Moelle épinière, ICM , PICNIC Lab , Paris , France
| | - Sophie Demeret
- a AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurology , Paris , France
| | - Francis Bolgert
- a AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurology , Paris , France
| | - Nicolas Weiss
- a AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurology , Paris , France
| | - Alexandra Grinea
- a AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurology , Paris , France
| | - Clémence Marois
- a AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurology , Paris , France.,c INSERM, U 1127 , Paris , France.,d Institut du Cerveau et de la Moelle épinière, ICM , PICNIC Lab , Paris , France
| | - Marion Quirins
- c INSERM, U 1127 , Paris , France.,d Institut du Cerveau et de la Moelle épinière, ICM , PICNIC Lab , Paris , France
| | - Athena Demertzi
- c INSERM, U 1127 , Paris , France.,d Institut du Cerveau et de la Moelle épinière, ICM , PICNIC Lab , Paris , France
| | - Federico Raimondo
- c INSERM, U 1127 , Paris , France.,d Institut du Cerveau et de la Moelle épinière, ICM , PICNIC Lab , Paris , France
| | - Damien Galanaud
- e AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neuroradiology , Paris , France.,f Sorbonne Universités, UPMC Univ Paris 06 , Faculté de Médecine Pitié-Salpêtrière , Paris , France
| | - Marie-Odile Habert
- f Sorbonne Universités, UPMC Univ Paris 06 , Faculté de Médecine Pitié-Salpêtrière , Paris , France.,g AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Nuclear Medicine , Paris , France.,h Sorbonne Universités, UPMC Univ Paris 06 , CNRS, INSERM, Laboratoire d'Imagerie Biomédicale , Paris , France
| | - Denis Engemann
- c INSERM, U 1127 , Paris , France.,d Institut du Cerveau et de la Moelle épinière, ICM , PICNIC Lab , Paris , France
| | - Louis Puybasset
- f Sorbonne Universités, UPMC Univ Paris 06 , Faculté de Médecine Pitié-Salpêtrière , Paris , France.,i AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Anesthesiology , Paris , France
| | - Lionel Naccache
- a AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurology , Paris , France.,b AP-HP, Groupe hospitalier Pitié-Salpêtrière , Department of Neurophysiology , Paris , France.,c INSERM, U 1127 , Paris , France.,d Institut du Cerveau et de la Moelle épinière, ICM , PICNIC Lab , Paris , France.,f Sorbonne Universités, UPMC Univ Paris 06 , Faculté de Médecine Pitié-Salpêtrière , Paris , France
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Clarençon F, Bardinet É, Martinerie J, Pelbarg V, Menjot de Champfleur N, Gupta R, Tollard E, Soto-Ares G, Ibarrola D, Schmitt E, Tourdias T, Degos V, Yelnik J, Dormont D, Puybasset L, Galanaud D. Lesions in deep gray nuclei after severe traumatic brain injury predict neurologic outcome. PLoS One 2017; 12:e0186641. [PMID: 29095850 PMCID: PMC5667824 DOI: 10.1371/journal.pone.0186641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study evaluates the correlation between injuries to deep gray matter nuclei, as quantitated by lesions in these nuclei on MR T2 Fast Spin Echo (T2 FSE) images, with 6-month neurological outcome after severe traumatic brain injury (TBI). MATERIALS AND METHODS Ninety-five patients (80 males, mean age = 36.7y) with severe TBI were prospectively enrolled. All patients underwent a MR scan within the 45 days after the trauma that included a T2 FSE acquisition. A 3D deformable atlas of the deep gray matter was registered to this sequence; deep gray matter lesions (DGML) were evaluated using a semi-quantitative classification scheme. The 6-month outcome was dichotomized into unfavorable (death, vegetative or minimally conscious state) or favorable (minimal or no neurologic deficit) outcome. RESULTS Sixty-six percent of the patients (63/95) had both satisfactory registration of the 3D atlas on T2 FSE and available clinical follow-up. Patients without DGML had an 89% chance (P = 0.0016) of favorable outcome while those with bilateral DGML had an 80% risk of unfavorable outcome (P = 0.00008). Multivariate analysis based on DGML accurately classified patients with unfavorable neurological outcome in 90.5% of the cases. CONCLUSION Lesions in deep gray matter nuclei may predict long-term outcome after severe TBI with high sensitivity and specificity.
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Affiliation(s)
- Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Paris VI University, Pierre et Marie Curie, Paris, France
- * E-mail:
| | - Éric Bardinet
- Institut du Cerveau et de la Moelle épinière–ICM. CNRS UMR 7225
| | | | - Vincent Pelbarg
- Bioinformatics and Biostatistics Plateform, IHU-A-ICM, Brain and Spine Institute (ICM), Paris, France
| | | | - Rajiv Gupta
- Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Eléonore Tollard
- Department of Neuroradiology, Rouen University Hospital, Rouen, France
| | - Gustavo Soto-Ares
- Department of Neuroradiology, Roger Salengro Hospital, Lille, France
| | - Danielle Ibarrola
- CERMEP, Pierre Wertheimer Neurological & Neurosurgical Hospital, Bron, France
| | | | - Thomas Tourdias
- Department of Neuroradiology, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Degos
- Paris VI University, Pierre et Marie Curie, Paris, France
- Neurosurgical Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris VI University, Paris, France
| | - Jérome Yelnik
- INSERM U679, Pitié-Salpêtrière Hospital, Paris VI University, Paris. France
| | - Didier Dormont
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Paris VI University, Pierre et Marie Curie, Paris, France
| | - Louis Puybasset
- Paris VI University, Pierre et Marie Curie, Paris, France
- Neurosurgical Intensive Care Unit, Pitié-Salpêtrière Hospital, Paris VI University, Paris, France
| | - Damien Galanaud
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
- Paris VI University, Pierre et Marie Curie, Paris, France
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Sair HI, Hannawi Y, Li S, Kornbluth J, Demertzi A, Di Perri C, Chabanne R, Jean B, Benali H, Perlbarg V, Pekar J, Luyt CE, Galanaud D, Velly L, Puybasset L, Laureys S, Caffo B, Stevens RD. Early Functional Connectome Integrity and 1-Year Recovery in Comatose Survivors of Cardiac Arrest. Radiology 2017; 287:247-255. [PMID: 29043908 DOI: 10.1148/radiol.2017162161] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose To assess whether early brain functional connectivity is associated with functional recovery 1 year after cardiac arrest (CA). Materials and Methods Enrolled in this prospective multicenter cohort were 46 patients who were comatose after CA. Principal outcome was cerebral performance category at 12 months, with favorable outcome (FO) defined as cerebral performance category 1 or 2. All participants underwent multiparametric structural and functional magnetic resonance (MR) imaging less than 4 weeks after CA. Within- and between-network connectivity was measured in dorsal attention network (DAN), default-mode network (DMN), salience network (SN), and executive control network (ECN) by using seed-based analysis of resting-state functional MR imaging data. Structural changes identified with fluid-attenuated inversion recovery and diffusion-weighted imaging sequences were analyzed by using validated morphologic scales. The association between connectivity measures, structural changes, and the principal outcome was explored with multivariable modeling. Results Patients underwent MR imaging a mean 12.6 days ± 5.6 (standard deviation) after CA. At 12 months, 11 patients had an FO. Patients with FO had higher within-DMN connectivity and greater anticorrelation between SN and DMN and between SN and ECN compared with patients with unfavorable outcome, an effect that was maintained after multivariable adjustment. Anticorrelation of SN-DMN predicted outcomes with higher accuracy than fluid-attenuated inversion recovery or diffusion-weighted imaging scores (area under the receiver operating characteristic curves, respectively, 0.88, 0.74, and 0.71). Conclusion MR imaging-based measures of cerebral functional network connectivity obtained in the acute phase of CA were independently associated with FO at 1 year, warranting validation as early markers of long-term recovery potential in patients with anoxic-ischemic encephalopathy. © RSNA, 2017.
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Affiliation(s)
- Haris I Sair
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Yousef Hannawi
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Shanshan Li
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Joshua Kornbluth
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Athena Demertzi
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Carol Di Perri
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Russell Chabanne
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Betty Jean
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Habib Benali
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Vincent Perlbarg
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - James Pekar
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Charles-Edouard Luyt
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Damien Galanaud
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Lionel Velly
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Louis Puybasset
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Steven Laureys
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Brian Caffo
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
| | - Robert D Stevens
- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
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- From the Departments of Radiology and Radiological Science (H.I.S., R.D.S.), Anesthesiology and Critical Care Medicine (Y.H., R.D.S.), Neurology (Y.H., R.D.S.), and Neurosurgery (R.D.S.), Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD 21287; Department of Biostatistics, Indiana University Fairbanks School of Public Health, Indianapolis, Ind (S.L.); Department of Neurology, Tufts University School of Medicine, Boston, Mass (J.K.); Institut du Cerveau et de la Moelle Épinière, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (A.D.); Coma Science Group and Department of Neurology, University of Liège, Liège, Belgium (C.D.P., S.L.); Departments of Anesthesia Resuscitation (R.C.) and Neuroradiology (B.J.), Centre Hospitalier Universitaire, Clermont-Ferrand, France; Functional Imaging Laboratory U678, Faculté de Médecine Pierre et Marie Curie, Paris, France (H.B., V.P.); F.M. Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Md (J.P.); Medical Resuscitation Service (C.E.L.), Department of Neuroradiology (D.G.), and Neurosurgical Resuscitation Service (L.V., L.P.), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie, Paris, France; and Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (B.C.)
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Debarle C, Perlbarg V, Puybasset L, Caron E, Lesimple B, Villain M, Pradat-Diehl P. Long-term outcome after severe traumatic brain injury (TBI) and correlation with volumetry and fractional anisotropy. Ann Phys Rehabil Med 2017. [DOI: 10.1016/j.rehab.2017.07.244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Weiss N, Rosselli M, Mouri S, Galanaud D, Puybasset L, Agarwal B, Thabut D, Jalan R. Modification in CSF specific gravity in acutely decompensated cirrhosis and acute on chronic liver failure independent of encephalopathy, evidences for an early blood-CSF barrier dysfunction in cirrhosis. Metab Brain Dis 2017; 32:369-376. [PMID: 27730496 DOI: 10.1007/s11011-016-9916-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 09/23/2016] [Indexed: 12/30/2022]
Abstract
Although hepatic encephalopathy (HE) on the background of acute on chronic liver failure (ACLF) is associated with high mortality rates, it is unknown whether this is due to increased blood-brain barrier permeability. Specific gravity of cerebrospinal fluid measured by CT is able to estimate blood-cerebrospinal fluid-barrier permeability. This study aimed to assess cerebrospinal fluid specific gravity in acutely decompensated cirrhosis and to compare it in patients with or without ACLF and with or without hepatic encephalopathy. We identified all the patients admitted for acute decompensation of cirrhosis who underwent a brain CT-scan. Those patients could present acute decompensation with or without ACLF. The presence of hepatic encephalopathy was noted. They were compared to a group of stable cirrhotic patients and healthy controls. Quantitative brain CT analysis used the Brainview software that gives the weight, the volume and the specific gravity of each determined brain regions. Results are given as median and interquartile ranges and as relative variation compared to the control/baseline group. 36 patients presented an acute decompensation of cirrhosis. Among them, 25 presented with ACLF and 11 without ACLF; 20 presented with hepatic encephalopathy grade ≥ 2. They were compared to 31 stable cirrhosis patients and 61 healthy controls. Cirrhotic patients had increased cerebrospinal fluid specific gravity (CSF-SG) compared to healthy controls (+0.4 %, p < 0.0001). Cirrhotic patients with ACLF have decreased CSF-SG as compared to cirrhotic patients without ACLF (-0.2 %, p = 0.0030) that remained higher than in healthy controls. The presence of hepatic encephalopathy did not modify CSF-SG (-0.09 %, p = 0.1757). Specific gravity did not differ between different brain regions according to the presence or absence of either ACLF or HE. In patients with acute decompensation of cirrhosis, and those with ACLF, CSF specific gravity is modified compared to both stable cirrhotic patients and healthy controls. This pattern is observed even in the absence of hepatic encephalopathy suggesting that blood-CSF barrier impairment is manifest even in absence of overt hepatic encephalopathy.
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Affiliation(s)
- Nicolas Weiss
- Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Hôpital de la Pitié Salpétrière, and INSERM UMR_S 938, CDR Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Unité de réanimation neurologique, Fédération de Neurologie, Pôle des maladies du système nerveux, Hôpital de la Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Institut de Neurosciences Translationnelles de Paris, Institut-Hospitalo-Universitaire-A-Institut du Cerveau et de la Moelle (IHU-A-ICM), Paris, France.
| | - Matteo Rosselli
- Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK
| | - Sarah Mouri
- Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Hôpital de la Pitié Salpétrière, and INSERM UMR_S 938, CDR Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- Soins Intensifs d'Hépatologie, Service d'Hépato-Gastroentérologie, Hôpital de la Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Galanaud
- Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Louis Puybasset
- Neuro-réanimation chirurgicale, département d'anesthésie-réanimation, Hôpital de la Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, France and Université Pierre et Marie Curie, Paris, France
| | - Banwari Agarwal
- Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK
| | - Dominique Thabut
- Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Hôpital de la Pitié Salpétrière, and INSERM UMR_S 938, CDR Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- Soins Intensifs d'Hépatologie, Service d'Hépato-Gastroentérologie, Hôpital de la Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rajiv Jalan
- Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK
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Velasquez T, Mackey G, Lusk J, Kyle UG, Fontenot T, Marshall P, Shekerdemian LS, Coss-Bu JA, Nishigaki A, Yatabe T, Tamura T, Yamashita K, Yokoyama M, Ruiz-Rodriguez JC, Encina B, Belmonte R, Troncoso I, Tormos P, Riveiro M, Baena J, Sanchez A, Bañeras J, Cordón J, Duran N, Ruiz A, Caballero J, Nuvials X, Riera J, Serra J, Rutten AMF, van Ieperen SNM, Der Kinderen EPHM, Van Logten T, Kovacikova L, Skrak P, Zahorec M, Kyle UG, Akcan-Arikan A, Silva JC, Mackey G, Lusk J, Goldsworthy M, Shekerdemian LS, Coss-Bu JA, Wood D, Harrison D, Parslow R, Davis P, Pappachan J, Goodwin S, Ramnarayan P, Chernyshuk S, Yemets H, Zhovnir V, Pulitano’ SM, De Rosa S, Mancino A, Villa G, Tosi F, Franchi P, Conti G, Patel B, Khine H, Shah A, Sung D, Singer L, Haghbin S, Inaloo S, Serati Z, Idei M, Nomura T, Yamamoto N, Sakai Y, Yoshida T, Matsuda Y, Yamaguchi Y, Takaki S, Yamaguchi O, Goto T, Longani N, Medar S, Abdel-Aal IR, El Adawy AS, Mohammed HMEH, Mohamed AN, Parry SM, Knight LD, Denehy L, De Morton N, Baldwin CE, Sani D, Kayambu G, da Silva VZM, Phongpagdi P, Puthucheary ZA, Granger CL, Rydingsward JE, Horkan CM, Christopher KB, Muscedere J, Scott SH, Saha T, Hamilton A, Petsikas D, Payne D, Boyd JG, Puthucheary ZA, McNelly AS, Rawal J, McWilliams D, Connolly B, McPhail MJ, Sidhu P, Rowlerson A, Moxham J, Harridge SD, Hart N, Montgomery HE, Jovaisa T, Thomas B, Jones C, Gupta D, Wijayatilake DS, Shum HP, King HS, Chan KC, Tang KB, Yan WW, Arias CC, Latorre J, De La Rica AS, Reeves E, Garrido EM, Feijoo AM, Gancedo CH, Tofiño AL, Rodríguez FG, Gemmell LK, Campbell R, Doherty P, MacKay A, Singh N, Atkins G, Vitaller S, Nagib H, Prieto J, Del Arco A, Zayas B, Gomez C, Tirumala S, Pasha SA, Kumari BK, Martinez-Lopez P, Snelson C, Puerto-Morlán A, Nuevo-Ortega P, Pujol LM, Dolset RA, González BS, Riera SQ, Álvarez JT, Quintana S, Martínez L, Algarte R, Aitken LM, Sánchez B, Trenado J, Tomas E, Brock N, Viegas E, Filipe E, Cottle D, Traynor T, Martínez MVT, Márquez MP, Rattray J, Gómez LC, Martínez NA, Muñoz JMM, Bellver BQ, Varea MM, Llorente MÁA, Calvo CP, Hillier SD, Faulds MC, Hendra H, Kenardy J, Lawrence N, Maekawa K, Hayakawa M, Ono Y, Kodate A, Sadamoto Y, Tominaga N, Mizugaki A, Murakami H, Yoshida T, Hull AM, Katabami K, Wada T, Sawamura A, Gando S, Silva S, Kerhuel L, Malagurski B, Citerio G, Chabanne R, Laureys S, Ullman A, Puybasset L, Nobile L, Pognuz ER, Rossetti AO, Verginella F, Gaspard N, Creteur J, Ben-Hamouda N, Oddo M, Taccone FS, Le Brocque R, Ono Y, Hayakawa M, Iijima H, Maekawa K, Kodate A, Sadamoto Y, Mizugaki A, Murakami H, Katabami K, Wada T, Mitchell M, Sawamura A, Gando S, Kodate A, Katabami K, Wada T, Ono Y, Maekawa K, Hayakawa M, Sawamura A, Gando S, Davis C, Andersen LW, Raymond T, Berg R, Nadkarni V, Grossestreuer A, Kurth T, Donnino M, Krüger A, Ostadal P, Janotka M, Macfarlane B, Vondrakova D, Kongpolprom N, Cholkraisuwat J, Pekkarinen PT, Ristagno G, Masson S, Latini R, Bendel S, Ala-Kokko T, Varpula T, Azevedo JC, Vaahersalo J, Hoppu S, Tiainen M, Mion MM, Plebani M, Pettilä V, Skrifvars M, Son Y, Kim KS, Suh GJ, Rocha LL, Kwon WY, Ko JI, Park MJ, Cavicchi FZ, Iesu E, Nobile L, Vincent JL, Creteur J, Taccone FS, Tanaka H, De Freitas FFM, Otani N, Ode S, Ishimatsu S, Martínez L, Algarte R, Sánchez B, Romero I, Martínez F, Quintana S, Trenado J, Cavalheiro AM, Vondrakova D, Ostadal P, Kruger A, Janotka M, Malek F, Neuzil P, Yeh YC, Chen YS, Wang CH, Huang CH, Lucinio NM, Chao A, Lee CT, Lai CH, Chan WS, Cheng YJ, Sun WZ, Kaese S, Horstmann C, Lebiedz P, Mourad M, Lobato MS, Gaudard P, Eliet J, Zeroual N, Colson P, Ostadal P, Mlcek M, Hrachovina M, Kruger A, Vondrakova D, Janotka M, Ebeling G, Mates M, Hala P, Kittnar O, Neuzil P, Jacky A, Rudiger A, Spahn DR, Bettex DA, Kara A, Akin S, Kraegpoeth A, Dos reis Miranda D, Struijs A, Caliskan K, van Thiel RJ, Dubois EA, de Wilde W, Zijlstra F, Gommers D, Ince C, Marca L, Laerkner E, Xini A, Mongkolpun W, Cordeiro CPR, Leite RT, Lheureux O, Bader A, Rincon L, Santacruz C, Preiser JC, Chao A, De Brito-Ashurst I, Chao AS, Chen YS, Kim W, Ahn C, Cho Y, Lim TH, Oh J, Choi KS, Jang BH, Ha JK, White C, Mecklenburg A, Stamm J, Soeffker G, Kubik M, Sydow K, Reichenspurner H, Kluge S, Braune S, Bergantino B, Ruberto F, Gregory S, Magnanimi E, Privato E, Zullino V, Bruno K, Pugliese F, Sales G, Girotto V, Vittone F, Brazzi L, Fritz C, Forni LG, Kimmoun A, Vanhuyse F, Trifan B, Orlowski S, Albuisson E, Tran N, Levy B, Chhor V, Joachim J, Follin A, Flowers E, Champigneulle B, Chatelon J, Fave G, Mantz J, Pirracchio R, Diaz DD, Villanova M, Aguirregabyria M, Andrade G, López L, Curtis A, Palencia E, John G, Cowan R, Hart R, Lake K, Litchfield K, Song JW, Lee YJ, Cho YJ, Choi S, Wood CA, Vermeir P, Vandijck D, Blot S, Mariman A, Verhaeghe R, Deveugele M, Vogelaers D, Chok L, Bachli EB, Bettex D, Siu K, Cottini SR, Keller E, Maggiorini M, Schuepbach R, Fiks T, Stiphout C, Grevelink M, Vaneker I, Ruijter A, Buise M, Venkatesan K, Spronk PE, Tena SA, Barrachina LG, Portillo JHR, Aznar GP, Campos LM, Sellés MDF, Tomás MA, Muncharaz AB, Skinner L, Muhammad JBH, Monsalvo S, Olavarria E, Stümpfle R, Na SJ, Park J, Chung CR, Park CM, Suh GY, Yang JH, Witter T, Ng L, Brousseau C, Butler MB, Erdogan M, Dougall PCM, Green RS, Abbott TEF, Torrance HDT, Cron N, Vaid N, Emmanuel J, Seet E, Siddiqui SS, Prabu N, Chaudhari HK, Patil VP, Divatia JV, Solanki S, Kulkarni AP, Gutierrez LAR, Bader A, Brasseur A, Baptista N, Lheureux O, Vincent JL, Creteur J, Taccone FS, Hempel D, Stauffert N, Recker F, Schröder T, Reusch S, Schleifer J, Escoval A, Breitkreutz R, Sjövall F, Perner A, Møller MH, Moraes RB, Borges FK, Guillen JAV, Zabaletta WJC, Ruiz-Ramos J, Ramirez P, Tomas E, Marqués-Miñana MR, Villarreal E, Gordon M, Sosa M, Concha P, Castellanos A, Menendez R, Ramírez CS, Santana MC, Balcázar LC, Agrawal R, Escalada SH, Viera MAH, Vázquez CFL, Díaz JJD, Campelo FA, Monroy NS, Santana PS, Santana SR, Gutiérrez-Pizarraya A, Garnacho-Montero J, Mathew R, Martin C, Baumstarck K, Leone M, Martín-Loeches I, Pirracchio R, Legrand M, Mainardi JL, Mantz J, Cholley B, Hubbard A, Varma A, Frontera PR, Vega LMC, Miguelena PRDG, Usón MCV, López AR, Clemente EA, Ibañes PG, Aguilar ALR, Palomar M, Olaechea P, Dima E, Uriona S, Vallverdu M, Catalan M, Nuvials X, Aragon C, Lerma FA, Jeon YD, Jeong WY, Kim MH, Jeong IY, Charitidou E, Ahn MY, Ahn JY, Han SH, Choi JY, Song YG, Kim JM, Ku NS, Bassi GL, Xiol EA, Senussi T, Perivolioti E, Idone FA, Motos A, Chiurazzi C, Travierso C, Fernández-Barat L, Amaro R, Hua Y, Ranzani OT, Bobi Q, Rigol M, Pratikaki M, Torres A, Fernández IF, Soler EA, de Vera APR, Pastor EE, Hernandis V, Ros Martínez J, Rubio RJ, Torner MM, Brugger SC, Vrettou C, Eroles AA, Moles SI, Cabello JT, Schoenenberger JA, Casals XN, Vidal MV, Garrido BB, Martinez MP, Mirabella L, Cotoia A, Giannopoulos A, Tullo L, Stella A, Di Bello F, Di Gregorio A, Dambrosio M, Cinnella G, Rosario LEDLC, Lesmes SPG, Romero JCG, Herrera ANG, Zakynthinos S, Pertuz EDD, Sánchez MJG, Sanz ER, Hualde JB, Hernández AA, Ramirez JR, Takahashi H, Kazutoshi F, Okada Y, Oobayashi W, Routsi C, Naito T, Baidya DK, Maitra S, Anand RK, Ray BR, Arora MK, Ruffini C, Rota L, Corona A, Sesana G, Atchade E, Ravasi S, Catena E, Naumann DN, Mellis C, Husheer SL, Bishop J, Midwinter MJ, Hutchings S, Corradi F, Brusasco C, Houzé S, Manca T, Ramelli A, Lattuada M, Nicolini F, Gherli T, Vezzani A, Young A, Carmona AF, Santiago AI, Guillamon LN, Jean-Baptiste S, Delgado MJG, Delgado-Amaya M, Curiel-Balsera E, Rivera-Romero L, Castillo-Lorente E, Carrero-Gómez F, Aguayo-DeHoyos E, Healey AJ, Cameron C, Jiao L, Thabut G, Stümpfle R, Pérez A, Martin S, del Moral OL, Toval S, Rico J, Aldecoa C, Oguzhan K, Demirkiran O, Kirman M, Genève C, Bozbay S, Kosuk ME, Asyralyyeva G, Dilek M, Duzgun M, Telli S, Aydin M, Yilmazer F, Hodgson LE, Dimitrov BD, Tanaka S, Stubbs C, Forni LG, Venn R, Vedage D, Shawaf S, Naran P, Sirisena N, Kinnear J, Dimitrov BD, Hodgson LE, Lortat-Jacob B, Stubbs C, Forni LG, Venn R, Londoño JG, Cardenas CL, Ginés AS, Gubianas CM, Sánchez EC, Sirvent JM, Panafidina V, Augustin P, Shlyk I, Ilyina V, Judickas S, Kezyte G, Urbanaviciute I, Serpytis M, Gaizauskas E, Sipylaite J, Sprung CL, Munteanu G, Desmard M, Morales RC, Kasdan H, Volker T, Reiter A, Cohen Y, Himmel Y, Meissonnier J, Banderas-Bravo ME, Gómez-Jiménez C, García-Martínez MV, Montravers P, Martínez-Carmona JF, Fernández-Ortega JF, O‘Dwyer MJ, Starczewska M, Wilks M, Vincent JL, Torsvik M, Gustad LT, Bangstad IL, Vinje LJ, de Molina FJG, Damås JK, Solligård E, Mehl A, Tsunoda M, Kang M, Saito M, Saito N, Akizuki N, Namiki M, Takeda M, Barbadillo S, Yuzawa J, Yaguchi A, Frantzeskaki F, Tsirigotis P, Chondropoulos S, Paramythiotou E, Theodorakopoulou M, Stamouli M, Gkirkas K, Dimopoulou IK, Alejandro R, Makiko S, Tsunoda M, Kang M, Yuzawa J, Akiduki N, Namiki M, Takeda M, Yaguchi A, Preau S, Ambler M, Álvarez-Lerma F, Sigurta A, Saeed S, Singer M, Jochmans S, Chelly J, Vong LVP, Sy O, Serbource-Goguel J, Rolin N, Weyer CM, Vallés J, Abdallah RI, Adrie C, Vinsonneau C, Monchi M, Mayr U, Huber W, Karsten E, Lahmer T, Thies P, Henschel B, Catalán RM, Fischer G, Schmid RM, Ediboglu O, Ataman S, Naz I, Yaman G, Kirakli C, Su PL, Kou PS, Lin WC, Palencia E, Chen CW, Lozano JAB, Sánchez PC, Francioni JEB, Ferrón FR, Simón JMS, Riad Z, Mezidi M, Aublanc M, Perinel S, Jareño A, Lissonde F, Louf-Durier A, Yonis H, Tapponnier R, Richard JC, Louis B, Guérin C, Mezidi M, Yonis H, Aublanc M, Granada RM, Lissonde F, Louf-Durier A, Perinel S, Tapponnier R, Richard JC, Guérin C, Marmanidou K, Oikonomou M, Nouris C, Loizou C, Ignacio ML, Soilemezi E, Matamis D, Somhorst P, Gommers D, Hayashi K, Hirayama T, Yumoto T, Tsukahara K, Iida A, Nosaka N, Cui N, Sato K, Ugawa T, Nakao A, Ujike Y, Hirohata S, Mojoli F, Torriglia F, Giannantonio M, Orlando A, Bianzina S, Liu D, Tavazzi G, Mongodi S, Pozzi M, Iotti GA, Braschi A, Jansen D, Gadgil S, Doorduin 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ESICM LIVES 2016: part three. Intensive Care Med Exp 2016. [PMCID: PMC5042925 DOI: 10.1186/s40635-016-0100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Martínez ÁF, Lai CH, Hsu YC, Yeh YC, Cheng YJ, Colella V, Zarrillo N, D’Amico M, Forfori F, Pezza B, Laddomada T, Aliaga SM, Beltramelli V, Pizzaballa ML, Doronzio A, Balicco B, Kiers D, van der Heijden W, Gerretsen J, de Mast Q, el Messaoudi S, Rongen G, Para LH, Gomes M, Kox M, Pickkers P, Riksen NP, Kashiwagi Y, Okada M, Hayashi K, Inagaki Y, Fujita S, Nakamae MN, Payá JM, Kang YR, Souza RB, Liberatore AMA, Koh IHJ, Blet A, Sadoune M, Lemarié J, Bihry N, Bern R, Polidano E, Mulero FR, Merval R, Launay JM, Lévy B, Samuel JL, Mebazaa A, Hartmann J, Harm S, Weber V, Guerci P, Ince Y, Heeman P, Ergin B, Ince C, Uz Z, Massey M, Ince Y, Papatella R, Bulent E, Guerci P, Toraman F, Ince C, Longbottom ER, Torrance HD, Owen HC, Hinds CJ, Pearse RM, O’Dywer MJ, Trogrlic Z, van der Jagt M, Lingsma H, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, van Achterberg T, Bakker J, Gommers DAMPJ, Ista E, Krajčová A, Waldauf P, Duška F, Shah A, Roy N, McKechnie S, Doree C, Fisher S, 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Koulouras V, Aron J, Lumley G, Milliken D, Dhadwal K, McGrath BA, Lynch SJ, Bovento B, Sharpe G, Grainger E, Pieri-Davies S, Wallace S, McGrath B, Lynch SJ, Bovento B, Grainger E, Pieri-Davies S, Sharpe G, Wallace S, Jung M, Cho J, Park H, Suh G, Kousha O, Paddle J, Gripenberg LG, Rehal MS, Wernerman J, Rooyackers O, de Grooth HJ, Choo WP, Spoelstra-de Man AM, Swart EL, Oudemans-van Straaten HM, Talan L, Güven G, Altıntas ND, Padar M, Uusvel G, Starkopf L, Starkopf J, Blaser AR, Kalaiselvan MS, Arunkumar AS, Renuka MK, Shivkumar RL, Volbeda M, ten Kate D, Hoekstra M, van der Maaten JM, Nijsten MW, Komaromi A, Rooyackers O, Wernerman J, Norberg Å, Smedberg M, Mori M, Pettersson L, Norberg Å, Rooyackers O, Wernerman J, Theodorakopoulou M, Christodoulopoulou T, Diamantakis A, Frantzeskaki F, Kontogiorgi M, Chrysanthopoulou E, Lygnos M, Diakaki C, Armaganidis A, Gundogan K, Dogan E, Coskun R, Muhtaroglu S, Sungur M, Ziegler T, Guven M, Kleyman A, Khaliq W, Andreas D, Singer M, Meierhans R, Schuepbach R, De Brito-Ashurst I, Zand F, Sabetian G, Nikandish R, Hagar F, Masjedi M, Maghsudi B, Vazin A, Ghorbani M, Asadpour E, Kao KC, Chiu LC, Hung CY, Chang CH, Li SH, Hu HC, El Maraghi S, Ali M, Rageb D, Helmy M, Marin-Corral J, Vilà C, Masclans JR, Vàzquez A, Martín-Loeches I, Díaz E, Yébenes JC, Rodriguez A, Álvarez-Lerma F, Varga N, Cortina-Gutiérrez A, Dono L, Martínez-Martínez M, Maldonado C, Papiol E, Pérez-Carrasco M, Ferrer R, Nweze K, Morton B, Welters I, Houard M, Voisin B, Ledoux G, Six S, Jaillette E, Nseir S, Romdhani S, Bouneb R, Loghmari D, Aicha NB, Ayachi J, Meddeb K, Chouchène I, Khedher A, Boussarsar M, Chan KS, Yu WL, Marin-Corral J, Vilà C, Masclans JR, Nolla J, Vidaur L, Bonastre J, Suberbiola B, Guerrero JE, Rodriguez A, Coll NR, Jiménez GJ, Brugger SC, Calero JC, Garrido BB, García M, Martínez MP, Vidal MV, de la Torre MC, Vendrell E, Palomera E, Güell E, Yébenes JC, Serra-Prat M, Bermejo-Martín JF, Almirall J, Tomas E, Escoval A, Froe F, Pereira MHV, Velez N, Viegas E, Filipe E, Groves C, Reay M, Chiu LC, Hu HC, Hung CY, Chang CH, Li SH, Kao KC, Ballin A, Facchin F, Sartori G, Zarantonello F, Campello E, Radu CM, Rossi S, Ori C, Simioni P, Umei N, Shingo I, Santos AC, Candeias C, Moniz I, Marçal R, e Silva ZC, Ribeiro JM, Georger JF, Ponthus JP, Tchir M, Amilien V, Ayoub M, Barsam E, Martucci G, Panarello G, Tuzzolino F, Capitanio G, Ferrazza V, Carollo T, Giovanni L, Arcadipane A, Sánchez ML, González-Gay MA, Díaz FJL, López MIR, Zogheib E, Villeret L, Nader J, Bernasinski M, Besserve P, Caus T, Dupont H, Morimont P, Habran S, Hubert R, Desaive T, Blaffart F, Janssen N, Guiot J, Pironet A, Dauby P, Lambermont B, Zarantonello F, Ballin A, Facchin F, Sartori G, Campello E, Pettenuzzo T, Citton G, Rossi S, Simioni P, Ori C, Kirakli C, Ediboglu O, Ataman S, Yarici M, Tuksavul F, Keating S, Gibson A, Gilles M, Dunn M, Price G, Young N, Remeta P, Bishop P, Zamora MDF, Muñoz-Bono J, Curiel-Balsera E, Aguilar-Alonso E, Hinojosa R, Gordillo-Brenes A, Arboleda-Sánchez JA, Skorniakov I, Vikulova D, Whiteley C, Shaikh O, Jones A, Ostermann M, Forni L, Scott M, Sahatjian J, Linde-Zwirble W, Hansell D, Laoveeravat P, Srisawat N, Kongwibulwut M, Peerapornrattana S, Suwachittanont N, Wirotwan TO, Chatkaew P, Saeyub P, Latthaprecha K, Tiranathanagul K, Eiam-ong S, Kellum JA, Berthelsen RE, Perner A, Jensen AEK, Jensen JU, Bestle MH, Gebhard DJ, Price J, Kennedy CE, Akcan-Arikan A, Liberatore AMA, Souza RB, Martins AMCRPF, Vieira JCF, Kang YR, Nakamae MN, Koh IHJ, Hamed K, Khaled MM, Soliman RA, Mokhtar MS, Seller-Pérez G, Arias-Verdú D, Llopar-Valdor E, De-Diós-Chacón I, Quesada-García G, Herrera-Gutierrez ME, Hafes R, Carroll G, Doherty P, Wright C, Vera IGG, Ralston M, Gemmell ML, MacKay A, Black E, Wright C, Docking RI, Appleton R, Ralston MR, Gemmell L, Appleton R, Wright C, Docking RI, Black E, Mackay A, Rozemeijer S, Mulier JLGH, Röttgering JG, Elbers PWG, Spoelstra-de Man AME, Tuinman PR, de Waard MC, Oudemans-van Straaten HM, Mejeni N, Nsiala J, Kilembe A, Akilimali P, Thomas G, Egerod I, Andersson AE, Fagerdahl AM, Knudsen V, Meddeb K, Cheikh AB, Hamdaoui Y, Ayachi J, Guiga A, Fraj N, Romdhani S, Sma N, Bouneb R, Chouchene I, Khedher A, Bouafia N, Boussarsar M, Amirian A, Ziaian B, Masjedi M, Fleischmann C, Thomas-Rueddel DO, Schettler A, Schwarzkopf D, Stacke A, Reinhart K, Filipe E, Escoval A, Martins A, Sousa P, Velez N, Viegas E, Tomas E, Snell G, Matsa R, Paary TTS, Kalaiselvan MS, Cavalheiro AM, Rocha LL, Vallone CS, Tonilo A, Lobato MDS, Malheiro DT, Sussumo G, Lucino NM, Zand F, Rosenthal VD, Masjedi M, Sabetian G, Maghsudi B, Ghorbani M, Dashti AS, Yousefipour A, Goodall JR, Williamson M, Tant E, Thomas N, Balci C, Gonen C, Haftacı E, Gurarda H, Karaca E, Paldusová B, Zýková I, Šímová D, Houston S, D’Antona L, Lloyd J, Garnelo-Rey V, Sosic M, Sotosek-Tokmazic V, Kuharic J, Antoncic I, Dunatov S, Sustic A, Chong CT, Sim M, Lyovarin T, Díaz FMA, Galdó SN, Garach MM, Romero OM, Bailón AMP, Pinel AC, Colmenero M, Gritsan A, Gazenkampf A, Korchagin E, Dovbish N, Lee RM, Lim MPP, Chong CT, Lim BCL, See JJ, Assis R, Filipe F, Lopes N, Pessoa L, Pereira T, Catorze N, Aydogan MS, Aldasoro C, Marchio P, Jorda A, Mauricio MD, Guerra-Ojeda S, Gimeno-Raga M, Colque-Cano M, Bertomeu-Artecero A, Aldasoro M, Valles SL, Tonon D, Triglia T, Martin JC, Alessi MC, Bruder N, Garrigue P, Velly L, Spina S, Scaravilli V, Marzorati C, Colombo E, Savo D, Vargiolu A, Cavenaghi G, Citerio G, Andrade AHV, Bulgarelli P, Araujo JAP, Gonzalez V, Souza VA, Costa A, Massant C, Filho CACA, Morbeck RA, Burgo LE, van Groenendael R, van Eijk LT, Leijte GP, Koeneman B, Kox M, Pickkers P, García-de la Torre A, de la Torre-Prados M, Fernández-Porcel A, Rueda-Molina C, Nuevo-Ortega P, Tsvetanova-Spasova T, Cámara-Sola E, García-Alcántara A, Salido-Díaz L, Liao X, Feng T, Zhang J, Cao X, Wu Q, Xie Z, Li H, Kang Y, Winkler MS, Nierhaus A, Mudersbach E, Bauer A, Robbe L, Zahrte C, Schwedhelm E, Kluge S, Zöllner C, Morton B, Mitsi E, Pennington SH, Reine J, Wright AD, Parker R, Welters ID, Blakey JD, Rajam G, Ades EW, Ferreira DM, Wang D, Kadioglu A, Gordon SB, Koch R, Kox M, Rahamat-Langedoen J, Schloesser J, de Jonge M, Pickkers P, Bringue J, Guillamat-Prats R, Torrents E, Martinez ML, Camprubí-Rimblas M, Artigas A, Blanch L, Park SY, Park YB, Song DK, Shrestha S, Park SH, Koh Y, Park MJ, Hong CW, Lesur O, Coquerel D, Sainsily X, Cote J, Söllradl T, Murza A, Dumont L, Dumaine R, Grandbois M, Sarret P, Marsault E, Salvail D, Auger-Messier M, Chagnon F, Lauretta MP, Greco E, Dyson A, Singer M, Preau S, Ambler M, Sigurta A, Saeed S, Singer M, Sarıca LT, Zibandeh N, Genc D, Gul F, Akkoc T, Kombak E, Cinel L, Akkoc T, Cinel I, Pollen SJ, Arulkumaran N, Singer M, Torrance HD, Longbottom ER, Warnes G, Hinds CJ, Pennington DJ, Brohi K, O’Dwyer MJ, Kim HY, Na S, Kim J, Chang YF, Chao A, Shih PY, Lee CT, Yeh YC, Chen LW, Adriaanse M, Trogrlic Z, Ista E, Lingsma H, Rietdijk W, Ponssen HH, Schoonderbeek JF, Schreiner F, Verbrugge SJ, Duran S, Gommers DAMPJ, van der Jagt M, Funcke S, Sauerlaender S, Saugel B, Pinnschmidt H, Reuter DA, Nitzschke R, Perbet S, Biboulet C, Lenoire A, Bourdeaux D, Pereira B, Plaud B, Bazin JE, Sautou V, Mebazaa A, Constantin JM, Legrand M, Boyko Y, Jennum P, Nikolic M. ESICM LIVES 2016: part one. Intensive Care Med Exp 2016. [PMCID: PMC5042924 DOI: 10.1186/s40635-016-0098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Boyer T, Sigaut S, Puybasset L, Deltour S, Clarençon F, Degos V. From preoperative evaluation to stroke center: Management of postoperative acute ischemic stroke. Anaesth Crit Care Pain Med 2016; 35:299-305. [PMID: 27091105 DOI: 10.1016/j.accpm.2015.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/05/2015] [Indexed: 11/19/2022]
Abstract
Perioperative acute ischaemic stroke is a rare complication with potentially catastrophic outcomes. It has been shown that paying attention to perioperative neurological deficits and acute ischaemic stroke prevention proves to be beneficial in avoiding these catastrophic outcomes and may lead to determining early therapeutic interventions. This article reviews the perioperative management (covering diagnosis and treatment), prevention (covering surgery postponement, management with anticoagulant/antiplatelet and the growing interest in statins and beta-blockers) and intraoperative recommendations (covering anaesthetic techniques, ventilation strategies, transfusion and blood pressure management) specifically for the general surgical population. A summary of current treatments is enlightened by recently described evidence for the effectiveness of mechanical thrombectomy.
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Affiliation(s)
- Thomas Boyer
- Neurosurgical Anaesthesiology Department, La Pitié Salpêtrière Hospital, 75013 Paris, France; Paris VI University Pierre-et-Marie-Curie, 75013 Paris, France; Université Catholique de Louvain, Brussels, Belgium
| | | | - Louis Puybasset
- Neurosurgical Anaesthesiology Department, La Pitié Salpêtrière Hospital, 75013 Paris, France; Inserm U1141, Robert-Debré Hospital, 75019 Paris, France; Neuroscience Department, La Pitié Salpêtrière Hospital, 75013 Paris, France; Neuroradiology Department, La Pitié Salpêtrière Hospital, 75013 Paris, France; Paris VI University Pierre-et-Marie-Curie, 75013 Paris, France
| | - Sandrine Deltour
- Neuroscience Department, La Pitié Salpêtrière Hospital, 75013 Paris, France
| | - Frédéric Clarençon
- Neuroradiology Department, La Pitié Salpêtrière Hospital, 75013 Paris, France; Paris VI University Pierre-et-Marie-Curie, 75013 Paris, France
| | - Vincent Degos
- Neurosurgical Anaesthesiology Department, La Pitié Salpêtrière Hospital, 75013 Paris, France; Inserm U1141, Robert-Debré Hospital, 75019 Paris, France; Neuroscience Department, La Pitié Salpêtrière Hospital, 75013 Paris, France; Neuroradiology Department, La Pitié Salpêtrière Hospital, 75013 Paris, France; Paris VI University Pierre-et-Marie-Curie, 75013 Paris, France.
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Abstract
New French 2016' Act recognizes 3 new rights for patients at the end of their life: right to dead without futilities, right to have their wishes respected and right to be comfortable in all circumstances. Medical acts must not be continued in an unreasonable way. Futility is defined by useless, disproportionate or without another aim that an artificial life sustaining acts. For patients who cannot tell their wishes, a withdrawing or withholding decision of life sustaining treatments can be taken with a collegiate process. Doctors must always care about patient comfort with palliative care. Artificial hydration and nutrition can be considered as futile. Patients can write advanced directives or design confidence person to attest their wishes if they should be unable to do it. Doctors must respect advanced directives, except in emergency cases or if there are inappropriate. In such cases, the decision not to respect advanced directives must be taken collegially. Sedation is a therapeutic solution to alleviate refractory suffering for patients at the end of life, even if there is a risk to shorten their life, if the aim is to make patient comfortable and if it is the only way to achieve this goal. A specific right to deep and continuous sedation until death is created, only for patients with a short life prognosis (forhours to days). It is an exceptional practice with very strict conditions including a collegiate deliberation including non-medical team members. If they wish, patients at the end of life should be cared at home with comfort treatments if needed. Referent doctor must inform patients about their rights. An initial and continuous formation on this field is required. For every decision, it is important to keep a record in the patient chart. If not, it will be a fault.
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Affiliation(s)
- Bernard Devalois
- Centre hospitalier René-Dubos, service de médecine palliative, 95300 Pontoise, France.
| | - Louis Puybasset
- Hôpital Pitié-Salpêtrière, service de neuroréanimation chirurgicale, 75013 Paris, France
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Galanaud D, Perlbarg V, Puybasset L. Cohorte Coma. J Neuroradiol 2016. [DOI: 10.1016/j.neurad.2016.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Feriel J, Adamo F, Monneret D, Trehel-Tursis V, Favard S, Tsé C, Puybasset L, Bonnefont-Rousselot D, Imbert-Bismut F. S100B protein concentration measurement according to two different immunoassays. Clin Chem Lab Med 2016; 53:e169-71. [PMID: 25719325 DOI: 10.1515/cclm-2014-1090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/05/2015] [Indexed: 11/15/2022]
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