Evidence map›Paper›PMID 33304651›Full record

ArticlePeerJ2020

Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients.

Stanislas Kandelman, Jérémy Allary, Raphael Porcher, Cássia Righy, Clarissa Francisca Valdez, Frank Rasulo, Nicholas Heming, Guy Moneger, Eric Azabou, Guillaume Savary and 7 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in PeerJ, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.1field-weighted citation impact, top 50% of its field
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

1 citing paper in PubMed, 4 citations in OpenAlex.

  1. Article
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

17 authors at 9 institutions in 5 countries.

Stanislas KandelmanDepartment of Anesthesiology and Intensive Care Unit, Beaujon Hospital, University Denis Diderot, Clichy, France.
Jérémy AllaryDepartment of Anesthesiology and Intensive Care Unit, Beaujon Hospital, University Denis Diderot, Clichy, France.
Raphael PorcherCenter for Clinical Epidemiology, Assistance Publique Hôpitaux de Paris, Hotel Dieu Hospital, University Paris Descartes, Paris, France.ORCID 0000-0002-5277-4679
Cássia RighyIntensive Care Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.ORCID 0000-0002-9206-9552
Clarissa Francisca ValdezIntensive Care Unit, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil.
Frank RasuloDepartment of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.
Nicholas HemingGeneral Intensive Care Unit, Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France.
Guy MonegerGeneral Intensive Care Unit, Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France.
Eric AzabouDepartment of Physiology, INSERM U 1179, Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France.ORCID 0000-0002-9747-9972
Guillaume SavaryDepartment of Anesthesiology and Intensive Care Unit, Beaujon Hospital, University Denis Diderot, Clichy, France.
Djillali AnnaneGeneral Intensive Care Unit, Assistance Publique Hôpitaux de Paris, Raymond-Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France.ORCID 0000-0001-6805-8944
Fabrice ChretienLaboratory of Human Histopathology and Animal Models, Institut Pasteur, Paris, France.
Nicola LatronicoDepartment of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.ORCID 0000-0002-2521-5871
Fernando Augusto BozzaInstituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil.ORCID 0000-0003-4878-0256
Benjamin RohautDepartment of Neurology, Intensive Care Unit, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, Sorbonne Universités, Faculté de Médecine Pitié-Salpêtrière, Paris, France, Paris, France.ORCID 0000-0001-6752-8756
Tarek SharsharLaboratory of Human Histopathology and Animal Models, Institut Pasteur, Paris, France.
Groupe d’Exploration Neurologique en Réanimation (GENeR)
Assistance Publique – Hôpitaux de Paris · FRHôpital Beaujon · FRAzienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia · ITInstituto Estadual do Cérebro Paulo Niemeyer · BRInstitut Pasteur · FRD’Or Institute for Research and Education · BRInserm · FRSorbonne Université · FRUniversité Paris Cité · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDeep sedation may hamper the detection of neurological deterioration in brain-injured patients. Impaired brainstem reflexes within the first 24 h of deep sedation are associated with increased mortality in non-brain-injured patients. Our objective was to confirm this association in brain-injured patients.

methodsThis was an observational prospective multicenter cohort study involving four neuro-intensive care units. We included acute brain-injured patients requiring deep sedation, defined by a Richmond Assessment Sedation Scale (RASS) < -3. Neurological assessment was performed at day 1 and included pupillary diameter, pupillary light, corneal and cough reflexes, and grimace and motor response to noxious stimuli. Pre-sedation Glasgow Coma Scale (GCS) and Simplified Acute Physiology Score (SAPS-II) were collected, as well as the cause of death in the Intensive Care Unit (ICU).

resultsA total of 137 brain-injured patients were recruited, including 70 (51%) traumatic brain-injured patients, 40 (29%) vascular (subarachnoid hemorrhage or intracerebral hemorrhage). Thirty patients (22%) died in the ICU. At day 1, the corneal (OR 2.69,

conclusionEarly (day 1) cough reflex abolition is an independent predictor of mortality in deeply sedated brain-injured patients. Abolished cough reflex likely reflects a brainstem dysfunction that might result from the combination of primary and secondary neuro-inflammatory cerebral insults revealed and/or worsened by sedation.

Indexed as

Brain injuryBrainstem dysfunctionCough reflexCritical careDeep sedationNeurological examinationNeuroprognosis

Identifiers

PMID33304651
PMCPMC7700733
OpenAlexW3107971768

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.