Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients - Sorbonne Université Access content directly
Journal Articles PeerJ Year : 2020

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

Raphael Porcher
Cássia Righy
Clarissa Francisca Valdez
  • Function : Author
Frank Rasulo
  • Function : Author
Nicholas Heming
  • Function : Author
Guy Moneger
  • Function : Author
Eric Azabou
Djillali Annane
Fabrice Chretien
  • Function : Author
Nicola Latronico
Fernando Augusto Bozza
Tarek Sharshar
  • Function : Author
  • PersonId : 1363688

Abstract

Background : Deep 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. Methods : This 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). Results A 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, p = 0.034) and cough reflexes (OR 5.12, p = 0.0003) were more frequently abolished in patients that died in the ICU. In a multivariate analysis, abolished cough reflex was associated with ICU mortality after adjustment to pre-sedation GCS, SAPS-II, RASS (OR: 5.19, 95% CI [1.92–14.1], p = 0.001) or dose of sedatives (OR: 8.89, 95% CI [2.64–30.0], p = 0.0004). Conclusion : Early (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.
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hal-04504779 , version 1 (14-03-2024)

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Stanislas Kandelman, Jérémy Allary, Raphael Porcher, Cássia Righy, Clarissa Francisca Valdez, et al.. Early abolition of cough reflex predicts mortality in deeply sedated brain-injured patients. PeerJ, 2020, 8, pp.e10326. ⟨10.7717/peerj.10326⟩. ⟨hal-04504779⟩
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