Evidence map›Paper›PMID 30071861›Full record

SynthesisCritical care (London, England)2018

Value and mechanisms of EEG reactivity in the prognosis of patients with impaired consciousness: a systematic review.

Eric Azabou, Vincent Navarro, Nathalie Kubis, Martine Gavaret, Nicholas Heming, Alain Cariou, Djillali Annane, Fréderic Lofaso, Lionel Naccache, Tarek Sharshar

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Critical care (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 45 papers.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

45 citing papers in PubMed.

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  6. Electroencephalography and Bispectral Index Reactivity to Predict Outcome in Unconscious Patients with Acute Severe Traumatic Brain Injury: A Prospective Observational Study.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Eric AzabouDepartment of Physiology and Department of Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm UMR 1173 Infection and Inflammation, University of Versailles Saint Quentin (UVSQ), University Paris-Saclay, Garches, Paris, France. eric.azabou@aphp.fr.ORCID 0000-0002-9747-9972
Vincent NavarroDepartment of Clinical Neurophysiology, Pitié-Salpêtrière Hospital, AP-HP, Inserm UMRS 1127, CNRS UMR 7225, Sorbonne Universities, Université Pierre et Marie Curie - UPMC Université Paris 06, Paris, France.
Nathalie KubisDepartment of Clinical Physiology, Lariboisière Hospital, AP-HP, Inserm U965, University of Paris Diderot, Sorbonne Paris Cité, Paris, France.
Martine GavaretDepartment of Clinical Neurophysiology, Sainte-Anne Hospital, Inserm U894, University Paris-Descartes, Paris, France.
Nicholas HemingDepartment of Physiology and Department of Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm UMR 1173 Infection and Inflammation, University of Versailles Saint Quentin (UVSQ), University Paris-Saclay, Garches, Paris, France.
Alain CariouMedical ICU, Cochin Hospital, AP-HP, Paris Cardiovascular Research Center, INSERM U970, Université Paris Descartes Sorbonne Paris Cité, Paris, France.
Djillali AnnaneDepartment of Physiology and Department of Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm UMR 1173 Infection and Inflammation, University of Versailles Saint Quentin (UVSQ), University Paris-Saclay, Garches, Paris, France.
Fréderic LofasoDepartment of Physiology and Department of Critical Care Medicine, Raymond Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Inserm UMR 1173 Infection and Inflammation, University of Versailles Saint Quentin (UVSQ), University Paris-Saclay, Garches, Paris, France.
Lionel NaccacheDepartment of Clinical Neurophysiology, Pitié-Salpêtrière Hospital, AP-HP, Inserm UMRS 1127, CNRS UMR 7225, Sorbonne Universities, Université Pierre et Marie Curie - UPMC Université Paris 06, Paris, France.
Tarek SharsharDepartment of Neuro-Intensive Care Medicine, Sainte-Anne Hospital, Paris-Descartes University, Paris, France.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundElectroencephalography (EEG) is a well-established tool for assessing brain function that is available at the bedside in the intensive care unit (ICU). This review aims to discuss the relevance of electroencephalographic reactivity (EEG-R) in patients with impaired consciousness and to describe the neurophysiological mechanisms involved.

methodsWe conducted a systematic search of the term "EEG reactivity and coma" using the PubMed database. The search encompassed articles published from inception to March 2018 and produced 202 articles, of which 42 were deemed relevant, assessing the importance of EEG-R in relationship to outcomes in patients with impaired consciousness, and were therefore included in this review.

resultsAlthough definitions, characteristics and methods used to assess EEG-R are heterogeneous, several studies underline that a lack of EEG-R is associated with mortality and unfavorable outcome in patients with impaired consciousness. However, preserved EEG-R is linked to better odds of survival. Exploring EEG-R to nociceptive, auditory, and visual stimuli enables a noninvasive trimodal functional assessment of peripheral and central sensory ascending pathways that project to the brainstem, the thalamus and the cerebral cortex. A lack of EEG-R in patients with impaired consciousness may result from altered modulation of thalamocortical loop activity by afferent sensory input due to neural impairment. Assessing EEG-R is a valuable tool for the diagnosis and outcome prediction of severe brain dysfunction in critically ill patients.

conclusionsThis review emphasizes that whatever the etiology, patients with impaired consciousness featuring a reactive electroencephalogram are more likely to have a favorable outcome, whereas those with a nonreactive electroencephalogram are prone to having an unfavorable outcome. EEG-R is therefore a valuable prognostic parameter and warrants a rigorous assessment. However, current assessment methods are heterogeneous, and no consensus exists. Standardization of stimulation and interpretation methods is needed.

Indexed as

PrognosisBrainConsciousness DisordersElectroencephalographyHumansBrain dysfunctionComaEEG reactivityIntensive care unitLateral lemniscusMortalityPrognosisSpinothalamic tract

Identifiers

PMID30071861
PMCPMC6091014

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.