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Critical Care
Published in: Critical Care 6/2012

Open Access 01-12-2012 | Research

Effects of the neurological wake-up test on clinical examination, intracranial pressure, brain metabolism and brain tissue oxygenation in severely brain-injured patients

Authors: Raimund Helbok, Pedro Kurtz, Michael J Schmidt, Morgan R Stuart, Luis Fernandez, Sander E Connolly, Kiwon Lee, Erich Schmutzhard, Stephan A Mayer, Jan Claassen, Neeraj Badjatia

Published in: Critical Care | Issue 6/2012

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Abstract

Introduction

Daily interruption of sedation (IS) has been implemented in 30 to 40% of intensive care units worldwide and may improve outcome in medical intensive care patients. Little is known about the benefit of IS in acutely brain-injured patients.

Methods

This prospective observational study was performed in a neuroscience intensive care unit in a tertiary-care academic center. Twenty consecutive severely brain-injured patients with multimodal neuromonitoring were analyzed for levels of brain lactate, pyruvate and glucose, intracranial pressure (ICP), cerebral perfusion pressure (CPP) and brain tissue oxygen tension (PbtO2) during IS trials.

Results

Of the 82 trial days, 54 IS-trials were performed as interruption of sedation and analgesics were not considered safe on 28 days (34%). An increase in the FOUR Score (Full Outline of UnResponsiveness score) was observed in 50% of IS-trials by a median of three (two to four) points. Detection of a new neurologic deficit occurred in one trial (2%), and in one-third of IS-trials the trial had to be stopped due to an ICP-crisis (> 20 mmHg), agitation or systemic desaturation. In IS-trials that had to be aborted, a significant increase in ICP and decrease in PbtO2 (P < 0.05), including 67% with critical values of PbtO2 < 20 mmHg, a tendency to brain metabolic distress (P < 0.07) was observed.

Conclusions

Interruption of sedation revealed new relevant clinical information in only one trial and a large number of trials could not be performed or had to be stopped due to safety issues. Weighing pros and cons of IS-trials in patients with acute brain injury seems important as related side effects may overcome the clinical benefit.
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Metadata
Title
Effects of the neurological wake-up test on clinical examination, intracranial pressure, brain metabolism and brain tissue oxygenation in severely brain-injured patients
Authors
Raimund Helbok
Pedro Kurtz
Michael J Schmidt
Morgan R Stuart
Luis Fernandez
Sander E Connolly
Kiwon Lee
Erich Schmutzhard
Stephan A Mayer
Jan Claassen
Neeraj Badjatia
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2012
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc11880

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