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

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Sarah Benghanem , Nathalie Kubis , Étienne Gayat , Ambre Loiodice , Estelle Pruvost‐Robieux , Tarek Sharshar , Arnaud Foucrier , Samy Figueiredo , Viviane Bouilleret , Étienne de Montmollin , François Bagate , Jean‐Pascal Lefaucheur , Bertrand Guidet , Emmanuelle Appartis , Alain Cariou , Olivier Varnet , Paul Henri Jost , Bruno Mégarbane , Vincent Degos , Loïc Le Guennec , Lionel Naccache , Stéphane Legriel , France Woimant , Charles Grégoire , David Cortier , Isabelle Crassard , Jean‐François Timsit , Mikaël Mazighi , Romain Sonneville , Tiare Ader , Éric Barré , Hélène Bout , Perrine Boursin , Eric Bodiguel , Damien Bresson , Omar Ben Hadj Salem , Alain Combes , Anne Chrisment , Magalie Collet , Jacque Duranteau , Sophie Crozier , Daniel Silva , Amexandre Demoule , Maxens Decavèle , Eric Delpierre , Jean Luc Diehl , Martin Dres , Frédéric Faugeras , Marie-Céline Fournier , Tobias Gauss , Coralie Gernez , Guillaume Géri , Dominique Hurel , Matthieu Jamme , L. Josse , Igor Jurcisin , Lionel Kerhuel , Catherine Lamy , Fariza Lamara , Aymeric Lancelot , Bertrand Lapergue , Christophe Lenclud , Mathilde Lermuzeaux , Éric Magalhaes , Éric Mariotte , Isabelle Malissin , Alain Maldjian , Nathalie Marin , Jérôme C. Martin , Thibault Martinez , Armand Mekontso Dessap , Mehran Monchi , Giulia Naïm , Hervé Outin , David Osman , G. Papin , Pierre Pasquier , Claire Pichereau , Matthieu Pissot , Keyvan Razazi , Danielle Reuter , Christian Richard , Stéphane Ruckly , Damien Roux , Caroline Schimpf , Quentin Staiquly , Jérôme Servan , Sébastien Tanaka , Laurie-Anne Thion , Karim Toumert , Widad Traki , Marc Tran , Philippe Vassel , Bernard Vigué , Daniel Zafimahazo , Jonathan Zarka ·

YOU? · · 2024 · Open Access · · DOI: https://doi.org/10.1186/s13054-024-04957-5

Introduction 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. Methods 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. Results 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). Conclusion 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.

Related Topics

Medicine

Mechanical Ventilation

Electroencephalography

Anesthesia

Internal Medicine

Ischemia

Mechanical Engineering

Psychiatry

Engineering

Concepts

Medicine Interquartile range Mechanical ventilation Stroke (engine) Prospective cohort study Electroencephalography Neurointensive care Modified Rankin Scale Cardiology Anesthesia Internal medicine Ischemic stroke Ischemia Mechanical engineering Psychiatry Engineering

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Type: article
Language: en
Landing Page: https://doi.org/10.1186/s13054-024-04957-5
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Title: Prognostic value of early EEG abnormalities in severe stroke patients requiring mechanical ventilation: a pre-planned analysis of the SPICE prospective multicenter study

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Publication year: 2024

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Authors: Sarah Benghanem, Nathalie Kubis, Étienne Gayat, Ambre Loiodice, Estelle Pruvost‐Robieux, Tarek Sharshar, Arnaud Foucrier, Samy Figueiredo, Viviane Bouilleret, Étienne de Montmollin, François Bagate, Jean‐Pascal Lefaucheur, Bertrand Guidet, Emmanuelle Appartis, Alain Cariou, Olivier Varnet, Paul Henri Jost, Bruno Mégarbane, Vincent Degos, Loïc Le Guennec, Lionel Naccache, Stéphane Legriel, France Woimant, Charles Grégoire, David Cortier, Isabelle Crassard, Jean‐François Timsit, Mikaël Mazighi, Romain Sonneville, Tiare Ader, Éric Barré, Hélène Bout, Perrine Boursin, Eric Bodiguel, Damien Bresson, Omar Ben Hadj Salem, Alain Combes, Anne Chrisment, Magalie Collet, Jacque Duranteau, Sophie Crozier, Daniel Silva, Amexandre Demoule, Maxens Decavèle, Eric Delpierre, Jean Luc Diehl, Martin Dres, Frédéric Faugeras, Marie-Céline Fournier, Tobias Gauss, Coralie Gernez, Guillaume Géri, Dominique Hurel, Matthieu Jamme, L. Josse, Igor Jurcisin, Lionel Kerhuel, Catherine Lamy, Fariza Lamara, Aymeric Lancelot, Bertrand Lapergue, Christophe Lenclud, Mathilde Lermuzeaux, Éric Magalhaes, Éric Mariotte, Isabelle Malissin, Alain Maldjian, Nathalie Marin, Jérôme C. Martin, Thibault Martinez, Armand Mekontso Dessap, Mehran Monchi, Giulia Naïm, Hervé Outin, David Osman, G. Papin, Pierre Pasquier, Claire Pichereau, Matthieu Pissot, Keyvan Razazi, Danielle Reuter, Christian Richard, Stéphane Ruckly, Damien Roux, Caroline Schimpf, Quentin Staiquly, Jérôme Servan, Sébastien Tanaka, Laurie-Anne Thion, Karim Toumert, Widad Traki, Marc Tran, Philippe Vassel, Bernard Vigué, Daniel Zafimahazo, Jonathan Zarka

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Concepts: Medicine, Interquartile range, Mechanical ventilation, Stroke (engine), Prospective cohort study, Electroencephalography, Neurointensive care, Modified Rankin Scale, Cardiology, Anesthesia, Internal medicine, Ischemic stroke, Ischemia, Mechanical engineering, Psychiatry, Engineering

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abstract_inverted_index.subarachnoid	156
abstract_inverted_index.suppression)	292
abstract_inverted_index.ventilation,	77
abstract_inverted_index.ventilation.	40
abstract_inverted_index.2.27–15.99)	236
abstract_inverted_index.Multivariable	123
abstract_inverted_index.abnormalities	33, 131
abstract_inverted_index.independently	238, 318
abstract_inverted_index.investigation	48
abstract_inverted_index.necessitating	9
abstract_inverted_index.(2017–2019),	56
abstract_inverted_index.(interquartile	169
abstract_inverted_index.electrographic	201
abstract_inverted_index.Prognostication	2
abstract_inverted_index.electroencephalogram	31
cited_by_percentile_year.max	97
cited_by_percentile_year.min	90
countries_distinct_count	1
institutions_distinct_count	96
sustainable_development_goals[0].id	https://metadata.un.org/sdg/3
sustainable_development_goals[0].score	0.75
sustainable_development_goals[0].display_name	Good health and well-being
citation_normalized_percentile.value	0.83433836
citation_normalized_percentile.is_in_top_1_percent	False
citation_normalized_percentile.is_in_top_10_percent	True