Parametrization of the dying brain: A case report from ICU bed-side EEG monitoring.

Autor: Zinn S; Department of Anesthesiology, Columbia University Medical Center, 10032 New York, NY, USA; Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, 60590 Frankfurt am Main, Germany. Electronic address: sz3253@cumc.columbia.edu., Dragovic SZ; Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine and Health, 81675 Munich, Germany., Kloka JA; Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, 60590 Frankfurt am Main, Germany., Willems LM; Goethe University Frankfurt, University Hospital, Department of Neurology, Epilepsy Center Frankfurt Rhine-Main, 60590 Frankfurt am Main, Germany., Harder S; Goethe University Frankfurt, Head of the IRB of the Faculty of Medicine, 60590 Frankfurt am Main, Germany., Kratzer S; Hessing Stiftung, Department of Anesthesiology, 86199 Augsburg, Germany., Zacharowski KD; Goethe University Frankfurt, University Hospital, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, 60590 Frankfurt am Main, Germany., Schneider G; Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine and Health, 81675 Munich, Germany., García PS; Department of Anesthesiology, Columbia University Medical Center, 10032 New York, NY, USA., Kreuzer M; Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine and Health, 81675 Munich, Germany.
Jazyk: angličtina
Zdroj: NeuroImage [Neuroimage] 2024 Dec 17; Vol. 305, pp. 120980. Date of Electronic Publication: 2024 Dec 17.
DOI: 10.1016/j.neuroimage.2024.120980
Abstrakt: Background: Cortical high-frequency activation immediately before death has been reported, raising questions about an enhanced conscious state at this critical time. Here, we analyzed an electroencephalogram (EEG) from a comatose patient during the dying process with a standard bedside monitor and spectral parameterization techniques.
Methods: We report neurophysiologic features of a dying patient without major cortical injury. Sixty minutes of frontal EEG activity was recorded using the Sedline™ monitor. Quantitative metrics of the frequency spectrum, the non-oscillatory 1/f characteristic, and signal complexity with Lemple-Ziv-Welch and permutation entropy were calculated. In addition to comparing the EEG trajectories over time, we provide a comparison to EEG records obtained from other studies with well-known vigilance states (sleep, anesthesia, and wake).
Results: Although we observed changes in high-frequency activation during the dying process, larger alterations of the aperiodic EEG components were also noted. These changes differed dramatically when compared to EEG records representative of wake, slow-wave sleep, or anesthesia. Although still fundamentally unique, the neuronal activity present in the dying brain is more similar to REM sleep than any other state we tested.
Conclusion: Even in patients with coma, temporal dynamics in quantitative EEG features (including the aperiodic components) can be observed in the final hour before death.
Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Sebastian Zinn reports financial support was provided by German Research Foundation - project number 525566280. Kai Zacharowski has received honoraria for participation in advisory board meetings for Haemonetics and Vifor and received speaker fees from CSL Behring, Masimo, Pharmacosmos, Boston Scientific, Salus, iSEP, Edwards and GE Healthcare. MK is named as an inventor for a patent dealing with spectral EEG features and age (U.S. Provisional Patent Application No. 62/914,183). Gerhard Schneider, Matthias Kreuzer and Srdjan Dragovic are named as inventors for a patent filed on a novel method for intraoperative EEG monitoring (U.S. Patent Application Serial No. 62/960,947) and are also named as inventors for a patent dealing with the EEG features during anesthesia emergence (U.S. Provisional Patent Application No. 63/459,294). PG research efforts are partly supported by a James S. McDonnell Foundation Grant #220023046 (PI: PS García, MD, PhD). Paul Garcia is a named inventor on several patents owned by Columbia University related to human EEG. PG is also a co-founder of Lantern Laboratory, Inc., a company that has been granted exclusive license by Columbia University to develop EEG technology related to these patents. MK received funding from Masimo Corporation, Narcotrend-Gruppe, Medtronic GmbH and Fresenius Kabi Deutschland GmbH for conducting EEG-based training for anaesthesiologists. No conflicts were declared by: Jan Kloka, Laurent Willems, Sebastian Harder, Stephan Kratzer.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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