Auditory discrimination improvement predicts awakening of postanoxic comatose patients treated with targeted temperature management at 36°C
| Autor: | Frédéric Zubler, Rebekka Kurmann, Christian Pfeiffer, Marzia De Lucia, Nathalie Ata Nguepno Nguissi, Magali Chytiris, Phanie Bidlingmeyer, Mauro Oddo, Andrea O. Rossetti, Matthias Haenggi |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Mismatch negativity Emergency Nursing Electroencephalography Targeted temperature management Audiology Acoustic Stimulation/methods Aged Aged 80 and over Coma/etiology Coma/mortality Coma/physiopathology Evoked Potentials Auditory Female Heart Arrest/complications Heart Arrest/therapy Humans Hypothermia Induced/methods Hypoxia-Ischemia Brain/etiology Middle Aged Predictive Value of Tests Prognosis Prospective Studies Cardiac arrest Coma EEG Multivariate decoding 03 medical and health sciences 0302 clinical medicine Hypothermia Induced medicine In patient 610 Medicine & health Prospective cohort study medicine.diagnostic_test business.industry 030208 emergency & critical care medicine Confidence interval Heart Arrest Acoustic Stimulation Predictive value of tests Anesthesia Hypoxia-Ischemia Brain Emergency Medicine medicine.symptom Cardiology and Cardiovascular Medicine business 030217 neurology & neurosurgery |
| Zdroj: | Resuscitation, vol. 118, pp. 89-95 |
| Popis: | Background Outcome prognostication in postanoxic comatose patients is more accurate in predicting poor than good recovery. Using electroencephalography recordings in patients treated with targeted temperature management at 33 °C (TTM 33), we have previously shown that improvement in auditory discrimination over the first days of coma predicted awakening. Given the increased application of a 36 °C temperature target (TTM 36), here we aimed at validating the predictive value of auditory discrimination in the TTM 36 setting. Methods In this prospective multicenter study, we analyzed the EEG responses to auditory stimuli from 60 consecutive patients from the first and second coma day. A semiautomatic decoding analysis was applied to single patient data to quantify discrimination performance between frequently repeated and deviant sounds. The decoding change from the first to second day was used for predicting patient outcome. Results We observed an increase in auditory discrimination in 25 out of 60 patients. Among them, 17 awoke from coma (68% positive predictive value; 95% confidence interval: 0.46–0.85). By excluding patients with electroencephalographic epileptiform features, 15 of 18 exhibited improvement in auditory discrimination (83% positive predictive value; 95% confidence interval: 0.59–0.96). Specificity of good outcome prediction increased after adding auditory discrimination to EEG reactivity. Conclusion These results suggest that tracking of auditory discrimination over time is informative of good recovery independent of the temperature target. This quantitative test provides complementary information to existing clinical tools by identifying patients with high chances of recovery and encouraging the maintenance of life support. |
| Databáze: | OpenAIRE |
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