The bispectral index and suppression ratio are very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest
The bispectral index and suppression ratio are very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest
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DOI：
10.1007/s00134-009-1691-1
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发表时间：
2010-02-01
影响因子：
38.9
通讯作者：
Riker, Richard R.
中科院分区：
文献类型：
--
作者：
Seder, David B.;Fraser, Gilles L.;Riker, Richard R.
评估双频指数 (BIS) 和抑制比 (SR) 作为心脏骤停后低温治疗期间神经系统结果的早期预测因素。在首次给予神经肌肉阻滞剂后，记录了 97 名患者的人口统计学数据、BIS1 和 SR1，结果采用盲法，并与出院时的脑功能类别 (CPC) 进行比较。构建接受者-操作者特征曲线和多重逻辑回归模型来预测良好（CPC 1-2，GO）和不良（CPC 3-5，PO）神经学结果。最终分析中排除了 14 名患者；其余 83 名患者中的 33 名 (40%) 被归类为 GO。 GO 患者的 BIS1 较高（37 [28-40] 比 7 [3-15]，p < 0.001）。 BIS1 < 22 预测 PO，似然比 (LR) 为 14.2，曲线下面积 (AUC) 为 0.91（95% CI 0.85-0.98，p < 0.001）。 SR1 千分之一日元48 预测 PO，LR 为 12.7，AUC 为 0.90（95% CI 0.83-0.98，p < 0.001）。 BIS1（Delta AUC 0.16，p = 0.006）和 SR1（Delta AUC 0.16，p = 0.005）都比自主循环恢复时间更好地预测结果。在我们使用中度镇静的单中心队列中，首次剂量间歇性神经肌肉阻滞后记录的脑电双频指数和抑制比是准确的，并且是心脏骤停后低温治疗期间神经系统结果的早期预测因子。
To evaluate the bispectral index (BIS) and suppression ratio (SR) as very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest.Demographic data, BIS1, and SR1 were recorded from 97 patients after the first dose of neuromuscular blockade, with outcomes blinded, and compared to the discharge Cerebral Performance Category (CPC). Receiver-operator characteristic curves and a multiple logistic regression model were constructed to predict good (CPC 1-2, GO) and poor (CPC 3-5, PO) neurological outcomes.Fourteen patients were excluded from the final analysis; 33 of the remaining 83 patients (40%) were classified as GO. The BIS1 was higher in patients with GO (37 [28-40] vs. 7 [3-15], p < 0.001). BIS1 < 22 predicted PO with a likelihood ratio (LR) of 14.2 and an area under the curve (AUC) of 0.91 (95% CI 0.85-0.98, p < 0.001). SR1 a parts per thousand yen48 predicted PO with a LR of 12.7 and an AUC of 0.90 (95% CI 0.83-0.98, p < 0.001). Both BIS1 (Delta AUC 0.16, p = 0.006) and SR1 (Delta AUC 0.16, p = 0.005) predicted outcomes better than the time to return of spontaneous circulation.In our single-center cohort utilizing moderate sedation, the bispectral index and suppression ratio recorded after the first dose of intermittent neuromuscular blockade were accurate and very early predictors of neurological outcome during therapeutic hypothermia after cardiac arrest.