Characterization of end-of-life electroencephalographic surges in critically ill patients
Characterization of end-of-life electroencephalographic surges in critically ill patients
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DOI：
10.1080/07481187.2017.1287138
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发表时间：
2017-01-01
期刊：
影响因子：
3.8
通讯作者：
Seneff, Michael G.
中科院分区：
文献类型：
--
作者：
Chawla, Lakhmir S.;Terek, Megan;Seneff, Michael G.
用于评估镇静水平的神经监测装置现在在许多医院环境中普遍使用。作者先前报告称，在循环停止时接受神经监测的患者死亡后，脑电描记（EEG）尖峰经常出现。除了最初的报告，其他研究人员随后在动物和人体研究中记录了寿命终止电涌（ELES）。ELES的频率、特征、强度和意义尚不清楚。有些人建议，不应在发生ELES之前宣布病人死亡，以便捐赠器官。如果临床实践被改变以等待ELES的存在，可能会对捐赠器官及其受体造成不利后果。为了更好地表征ELES，作者回顾性评估了连续患者中ELES的频率和性质。为了更好地记录ELES，他们收集了连续患者的神经监测，人口统计学和临床数据，这些患者在作为标准姑息治疗的一部分进行积极监测时死亡。这些数据是回顾性收集的，可作为方便的样本。作者评估了35例患者，其中7例经临床证实为脑死亡。脑死亡患者均未显示ELES。其余28例患者中有13例（46.4%）表现出ELES。所观察到的ELES被证明具有高频EEG信号。通过患者状态指数（TM）（PSI）测量的ELES平均峰值振幅为58.5 +/-25.7。在这项初步评估中，作者发现ELES在死亡的重症患者中很常见。ELES的确切原因和意义尚不清楚，需要进一步研究。
Neuromonitoring devices to assess level of sedation are now used commonly in many hospital settings. The authors previously reported that electroencephalicgraphic (EEG) spikes frequently occurred after the time of death in patients being neuromonitored at the time of cessation of circulation. In addition to the initial report, end-of-life electrical surges (ELES) have been subsequently documented in animal and human studies by other investigators. The frequency, character, intensity, and significance of ELES are unknown. Some have proposed that patients should not be declared dead for purposes of organ donation prior to the occurrence of an ELES. If clinical practice were altered to await the presence of an ELES, there could be detrimental consequences to donated organs and their recipients. To better characterize ELES, the authors retrospectively assessed the frequency and nature of ELES in serial patients. To better document ELES, they collected neuromonitoring, demographic, and clinical data on consecutive patients who expired while being actively monitored as part of their standard palliative care. These data were retrospectively collected when available as a convenience sample. The authors assessed 35 patients of which 7 were clinically confirmed as brain dead. None of the brain-dead patients displayed an ELES. Thirteen of the 28 remaining patients (46.4%) exhibited an ELES. The ELES observed were demonstrated to have high frequency EEG signal. The mean peak amplitude of ELES as measured by Patient State Index(TM) (PSI) was 58.5 +/- 25.7. In this preliminary assessment, the authors found that ELES are common in critically ill patients who succumb. The exact cause and significance of ELES remain unknown; further study is warranted.