Prognostic value of early EEG abnormalities in severe stroke patients requiring mechanical ventilation: a pre-planned analysis of the SPICE prospective multicenter study.

Humans Male Female Prospective Studies Respiration, Artificial / methods Aged Electroencephalography / methods Middle Aged Prognosis Stroke / physiopathology Intensive Care Units / statistics & numerical data Cohort Studies Aged, 80 and over

EEG reactivity Electroencephalogram Intensive care Prognostication Severe stroke

Journal

Critical care (London, England)

ISSN: 1466-609X

Titre abrégé: Crit Care

Pays: England

ID NLM: 9801902

Informations de publication

Date de publication:
23 May 2024

Historique:

received: 07 04 2024

accepted: 17 05 2024

medline: 24 5 2024

pubmed: 24 5 2024

entrez: 23 5 2024

Statut: epublish

Résumé

Prognostication of outcome in severe stroke patients necessitating invasive mechanical ventilation poses significant challenges. The objective of this study was to assess the prognostic significance and prevalence of early electroencephalogram (EEG) abnormalities in adult stroke patients receiving mechanical ventilation. This study is a pre-planned ancillary investigation within the prospective multicenter SPICE cohort study (2017-2019), conducted in 33 intensive care units (ICUs) in the Paris area, France. We included adult stroke patients requiring invasive mechanical ventilation, who underwent at least one intermittent EEG examination during their ICU stay. The primary endpoint was the functional neurological outcome at one year, determined using the modified Rankin scale (mRS), and dichotomized as unfavorable (mRS 4-6, indicating severe disability or death) or favorable (mRS 0-3). Multivariable regression analyses were employed to identify EEG abnormalities associated with functional outcomes. Of the 364 patients enrolled in the SPICE study, 153 patients (49 ischemic strokes, 52 intracranial hemorrhages, and 52 subarachnoid hemorrhages) underwent at least one EEG at a median time of 4 (interquartile range 2-7) days post-stroke. Rates of diffuse slowing (70% vs. 63%, p = 0.37), focal slowing (38% vs. 32%, p = 0.15), periodic discharges (2.3% vs. 3.7%, p = 0.9), and electrographic seizures (4.5% vs. 3.7%, p = 0.4) were comparable between patients with unfavorable and favorable outcomes. Following adjustment for potential confounders, an unreactive EEG background to auditory and pain stimulations (OR 6.02, 95% CI 2.27-15.99) was independently associated with unfavorable outcomes. An unreactive EEG predicted unfavorable outcome with a specificity of 48% (95% CI 40-56), sensitivity of 79% (95% CI 72-85), and positive predictive value (PPV) of 74% (95% CI 67-81). Conversely, a benign EEG (defined as continuous and reactive background activity without seizure, periodic discharges, triphasic waves, or burst suppression) predicted favorable outcome with a specificity of 89% (95% CI 84-94), and a sensitivity of 37% (95% CI 30-45). The absence of EEG reactivity independently predicts unfavorable outcomes at one year in severe stroke patients requiring mechanical ventilation in the ICU, although its prognostic value remains limited. Conversely, a benign EEG pattern was associated with a favorable outcome.

Identifiants

DOI: 10.1186/s13054-024-04957-5 PMID: 38783313

pubmed: 38783313

doi: 10.1186/s13054-024-04957-5

pii: 10.1186/s13054-024-04957-5

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

173

Investigateurs

Tiare Ader (T)

Eric Barré (E)

Hélène Bout (H)

Perrine Boursin (P)

Eric Bodiguel (E)

Damien Bresson (D)

Omar Ben Hadj Salem (OBH)

Alain Combes (A)

Anne Chrisment (A)

Magalie Collet (M)

Jacque Duranteau (J)

Sophie Crozier (S)

Daniel da Silva (D)

Amexandre Demoule (A)

Maxens Decavele (M)

Eric Delpierre (E)

Jean Luc Diehl (JL)

Martin Dres (M)

Frédéric Faugeras (F)

Marie-Céline Fournier (MC)

Tobias Gauss (T)

Coralie Gernez (C)

Guillaume Geri (G)

Dominique Hurel (D)

Matthieu Jamme (M)

Laurence Josse (L)

Igor Jurcisin (I)

Lionel Kerhuel (L)

Catherine Lamy (C)

Fariza Lamara (F)

Aymeric Lancelot (A)

Bertrand Lapergue (B)

Christophe Lenclud (C)

Mathilde Lermuzeaux (M)

Eric Magalhaes (E)

Eric Mariotte (E)

Isabelle Malissin (I)

Alain Maldjian (A)

Nathalie Marin (N)

Jérôme Martin (J)

Thibault Martinez (T)

Armand Mekontso Dessap (AM)

Mehran Monchi (M)

Giulia Naim (G)

Hervé Outin (H)

David Osman (D)

Gregory Papin (G)

Pierre Pasquier (P)

Claire Pichereau (C)

Matthieu Pissot (M)

Keyvan Razazi (K)

Danielle Reuter (D)

Christian Richard (C)

Stephane Ruckly (S)

Damien Roux (D)

Caroline Schimpf (C)

Quentin Staiquly (Q)

Jérôme Servan (J)

Sebastien Tanaka (S)

Laurie-Anne Thion (LA)

Karim Toumert (K)

Widad Traki (W)

Marc Tran (M)

Philippe Vassel (P)

Bernard Vigué (B)

Daniel Zafimahazo (D)

Jonathan Zarka (J)

Informations de copyright

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