Evidence map›Paper›PMID 40512201›Full record

Observational studyIntensive care medicine2025

Altered lower brainstem neurophysiological response is associated with mortality in deeply sedated critically ill patients.

Eléonore Bouchereau, Estelle Pruvost-Robieux, Shidasp Siami, Cendrine Chaffaut, Adrien Bouglé, Martine Gavaret, Nicholas Heming, Sivanthiny Sivanandamoorthy, Julie Zyss, Vincent Degos and 9 more

Registry-linked trialAbstract readObservational StudyMulticenter Study
PubMed Publisher
In one paragraph

Observational study in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02395861 (Evaluation of the Clinical and Electrophysiological Responses of the Brainstem in Patients With Alteration of Consciousness in Relation or Not With Sedation), which is not on this map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing 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.

NCT02395861 naunknown statusnot on this map

Evaluation of the Clinical and Electrophysiological Responses of the Brainstem in Patients With Alteration of Consciousness in Relation or Not With Sedation: Prognostic Study of Brain Reflexes

TypeinterventionalSponsorAssistance Publique - Hôpitaux de ParisRan2015 to 2019Enrolled400ConditionsAdult Patients With Alteration of Consciousness, Admitted Into the Intensive Care Unit (ICU)Armsneuro-electrophysiologic analyses
3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
  4. Article
  5. Article
  6. 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

19 authors.

Eléonore BouchereauAnesthesia and Intensive Care Department, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Paris, France.ORCID 0000-0003-3410-3457
Estelle Pruvost-RobieuxDepartment of Clinical Neurophysiology, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Paris, France.
Shidasp SiamiGeneral Intensive Care Unit, Sud-Essonne Hospital, Etampes, France.
Cendrine ChaffautDepartment of Biostatistics, Hôpital Saint-Louis, AP-HP, Paris, France.
Adrien BougléDepartment of Anesthesiology and Critical Care Medicine, Cardiology Institute, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
Martine GavaretDepartment of Clinical Neurophysiology, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Paris, France.
Nicholas HemingGeneral Intensive Care Unit, APHP, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France.
Sivanthiny SivanandamoorthyGeneral Intensive Care Unit, Sud-Essonne Hospital, Etampes, France.
Julie ZyssDepartment of Clinical Neurophysiology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
Vincent DegosDepartment of Anesthesiology and Critical Care, Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Paris, France.
Stanislas KandelmanDepartment of Anesthesiology, Royal Victoria Hospital, McGill University Health Center, Montreal, Canada.
Cassia Righy ShinotsukaDepartment of Neurointensive Care, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil.
Sarah BenghanemMedical Intensive Care Unit, Cochin Hospital, Assistance Publique - Hôpitaux de Paris-Centre (APHP-Centre), Paris, France.
Lionel NaccacheDepartment of Clinical Neurophysiology, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
Benjamin RohautDepartment of Neurology, Neuro-ICU & Brain Institute - ICM, Pitié-Salpêtrière Hospital APHP, Sorbonne Université, Paris, France.
Bertrand HermannAnesthesia and Intensive Care Department, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Paris, France.
Eric AzabouDepartment of Physiology and Department of Critical Care Medicine, Inserm UMR 1173 Infection and Inflammation, Raymond Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), University of Versailles Saint Quentin (UVSQ), University Paris-Saclay, Garches, Paris, France.
Sylvie ChevretDepartment of Biostatistics, Hôpital Saint-Louis, AP-HP, Paris, France.
Tarek SharsharAnesthesia and Intensive Care Department, GHU Paris Psychiatrie et Neurosciences, Pole Neuro, Sainte‑Anne Hospital, Paris, France. t.sharshar@ghu-paris.fr.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesAbsent cough reflex is associated with mortality in intensive care unit (ICU) patients requiring deep sedation, suggesting that lower brainstem dysfunction contributes to adverse outcomes. We conducted a multicenter observational cohort study to confirm this hypothesis by assessing the peak latency (PL) of the lower brainstem-generated P14 evoked potential (EP), which is slightly increased by sedatives. We aimed to demonstrate that a P14-PL > 16 ms is independently associated with day-28 mortality. PATIENTS AND

methodsMechanically ventilated adult patients, comatose or deeply sedated, brain injured or not, were included. At day 3, EPs were performed in patients remaining unconscious. The Simplified Acute Physiological Score (SAPSII), initial Glasgow Coma Scale (GCS), sedation depth, and brainstem reflexes were collected. The primary outcome was day-28 mortality. The secondary outcomes were delayed awakening and delirium after sedation discontinuation.

resultsBetween 2015 and 2019, 322 patients were included. EPs were performed in 264 (82%) patients, including 140 (53%) brain-injured and 251 (95%) deeply sedated patients. The median age, SAPSII and initial GCS were 62 [50; 71], 49 [40; 62] and 11 years [6; 15], respectively. A P14-PL > 16 ms was found in 76 (29%) patients and was associated with day-28 mortality (adjusted hazard ratio, 3.0; 95% confidence interval, [1.7-5.2]). Absent cough and pupillary light reflexes were associated with death. Only absent oculocephalogyric reflex was associated with delayed awakening (adjusted odds ratio, 2.1, 95%CI, [1.1-3.7]).

interpretationImpaired neurological and neurophysiological lower brainstem responses are associated with mortality in deeply sedated patients. Funded by the French Ministry of Health; PRORETRO; no. P120915; ClinicalTrials.gov registry: NCT02395861; date: 24 March 2015.

Indexed as

Brain StemCritical IllnessDeep SedationAdultAgedCohort StudiesFemaleGlasgow Coma ScaleHumansHypnotics and SedativesIntensive Care UnitsMaleMiddle AgedRespiration, ArtificialSimplified Acute Physiology ScoreHypnotics and SedativesBrain-injured patientsComaCritical careEvoked potentialsNeuroprognostication

Identifiers

PMID40512201

What OpenQuestion holds

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Registered trials

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.