Burst Suppression: Causes and Effects on Mortality in Critical Illness.

Autor: Hogan J; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.; Department of Biology, Brigham Young University, Provo, UT, USA., Sun H; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Aboul Nour H; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.; Department of Neurology, Henry Ford Hospital, Detroit, MI, USA., Jing J; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.; School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore, Singapore., Tabaeizadeh M; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Shoukat M; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Javed F; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Kassa S; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Edhi MM; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.; Brown Institute for Brain Science, Providence, RI, 02903, USA., Bordbar E; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Gallagher J; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Junior VM; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Ghanta M; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Shao YP; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Akeju O; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA., Cole AJ; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Rosenthal ES; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Zafar S; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Westover MB; Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. mwestover@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: Neurocritical care [Neurocrit Care] 2020 Oct; Vol. 33 (2), pp. 565-574.
DOI: 10.1007/s12028-020-00932-4
Abstrakt: Background: Burst suppression in mechanically ventilated intensive care unit (ICU) patients is associated with increased mortality. However, the relative contributions of propofol use and critical illness itself to burst suppression; of burst suppression, propofol, and critical illness to mortality; and whether preventing burst suppression might reduce mortality, have not been quantified.
Methods: The dataset contains 471 adults from seven ICUs, after excluding anoxic encephalopathy due to cardiac arrest or intentional burst suppression for therapeutic reasons. We used multiple prediction and causal inference methods to estimate the effects connecting burst suppression, propofol, critical illness, and in-hospital mortality in an observational retrospective study. We also estimated the effects mediated by burst suppression. Sensitivity analysis was used to assess for unmeasured confounding.
Results: The expected outcomes in a "counterfactual" randomized controlled trial (cRCT) that assigned patients to mild versus severe illness are expected to show a difference in burst suppression burden of 39%, 95% CI [8-66]%, and in mortality of 35% [29-41]%. Assigning patients to maximal (100%) burst suppression burden is expected to increase mortality by 12% [7-17]% compared to 0% burden. Burst suppression mediates 10% [2-21]% of the effect of critical illness on mortality. A high cumulative propofol dose (1316 mg/kg) is expected to increase burst suppression burden by 6% [0.8-12]% compared to a low dose (284 mg/kg). Propofol exposure has no significant direct effect on mortality; its effect is entirely mediated through burst suppression.
Conclusions: Our analysis clarifies how important factors contribute to mortality in ICU patients. Burst suppression appears to contribute to mortality but is primarily an effect of critical illness rather than iatrogenic use of propofol.
Databáze: MEDLINE
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