Observational studyPloS one2017
Brainstem response patterns in deeply-sedated critically-ill patients predict 28-day mortality.
Observational study in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04527198 (Brainstem Dysfunction in Ventilated and Deeply Sedated COVID-19 Critically Ill Patients), which is not on this map. Cited by 23 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Brainstem Dysfunction in Ventilated and Deeply Sedated COVID-19 Critically Ill Patients: a Prospective Observational Study
Who cites it
23 citing papers in PubMed, 2 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- The Relationship of the FOUR Score to Patient Outcome: A Systematic Review.Journal of neurotrauma · 2019Pooled it
- Value and mechanisms of EEG reactivity in the prognosis of patients with impaired consciousness: a systematic review.Critical care (London, England) · 2018Pooled it
- Prolonged P14 latency predicts mortality in deep sedation: implications for neuroprotective sedation strategies-author's reply.Intensive care medicine · 2025Article
- Altered lower brainstem neurophysiological response is associated with mortality in deeply sedated critically ill patients.Intensive care medicine · 2025Observational
- Management of severe acute encephalopathy in the ICU: an expert consensus statement from the french society of intensive care medicine.Annals of intensive care · 2025Review
- Electrophysiological monitoring of neurological functions at the acute phase of brain injury: An overview of current knowledge and future perspectives in the adult population.European journal of anaesthesiology and intensive care · 2024Review
- Intraoperative neurological pupil index and postoperative delirium and neurologic adverse events after cardiac surgery: an observational study.Scientific reports · 2023Observational
- Neurochemical effects of sepsis on the brain.Clinical science (London, England : 1979) · 2023Article
- [Delirium-assessment, prevention and treatment : Task in the interprofessional intensive care unit team].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2022Article
- Neurological monitoring and sedation protocols in the Liver Intensive Care Unit.Metabolic brain disease · 2022Review
- Cough as a neurological sign: What a clinician should know.World journal of critical care medicine · 2022Article
- Neuro-Inflammatory Response and Brain-Peripheral Crosstalk in Sepsis and Stroke.Frontiers in immunology · 2022Review
- Neuroimmune Regulation in Sepsis-Associated Encephalopathy: The Interaction Between the Brain and Peripheral Immunity.Frontiers in neurology · 2022Review
- Septic-Associated Encephalopathy: a Comprehensive Review.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2020Review
- Neuromonitoring of delirium with quantitative pupillometry in sedated mechanically ventilated critically ill patients.Critical care (London, England) · 2020Observational
- Brainstem dysfunction in critically ill patients.Critical care (London, England) · 2020Review
- Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients.PeerJ · 2020Article
- The Influence of Therapeutics on Prognostication After Cardiac Arrest.Current treatment options in neurology · 2019Review
- The Full Outline of UnResponsiveness (FOUR) Score and Its Use in Outcome Prediction: A Scoping Systematic Review of the Adult Literature.Neurocritical care · 2019Article
- Update in Neurocritical Care: a summary of the 2018 Paris international conference of the French Society of Intensive Care.Annals of intensive care · 2019Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
20 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
background and purposeDeep sedation is associated with acute brain dysfunction and increased mortality. We had previously shown that early-assessed brainstem reflexes may predict outcome in deeply sedated patients. The primary objective was to determine whether patterns of brainstem reflexes might predict mortality in deeply sedated patients. The secondary objective was to generate a score predicting mortality in these patients.
methodsObservational prospective multicenter cohort study of 148 non-brain injured deeply sedated patients, defined by a Richmond Assessment sedation Scale (RASS) <-3. Brainstem reflexes and Glasgow Coma Scale were assessed within 24 hours of sedation and categorized using latent class analysis. The Full Outline Of Unresponsiveness score (FOUR) was also assessed. Primary outcome measure was 28-day mortality. A "Brainstem Responses Assessment Sedation Score" (BRASS) was generated.
resultsTwo distinct sub-phenotypes referred as homogeneous and heterogeneous brainstem reactivity were identified (accounting for respectively 54.6% and 45.4% of patients). Homogeneous brainstem reactivity was characterized by preserved reactivity to nociceptive stimuli and a partial and topographically homogenous depression of brainstem reflexes. Heterogeneous brainstem reactivity was characterized by a loss of reactivity to nociceptive stimuli associated with heterogeneous brainstem reflexes depression. Heterogeneous sub-phenotype was a predictor of increased risk of 28-day mortality after adjustment to Simplified Acute Physiology Score-II (SAPS-II) and RASS (Odds Ratio [95% confidence interval] = 6.44 [2.63-15.8]; p<0.0001) or Sequential Organ Failure Assessment (SOFA) and RASS (OR [95%CI] = 5.02 [2.01-12.5]; p = 0.0005). The BRASS (and marginally the FOUR) predicted 28-day mortality (c-index [95%CI] = 0.69 [0.54-0.84] and 0.65 [0.49-0.80] respectively).
conclusionIn this prospective cohort study, around half of all deeply sedated critically ill patients displayed an early particular neurological sub-phenotype predicting 28-day mortality, which may reflect a dysfunction of the brainstem.
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Registered trials
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