دانلود رایگان مقاله انگلیسی اثر آرام بخش در الکتروانسفالوگرافی کمی پس از ایست قلب - الزویر 2018

abstract

Background: Electroencephalography (EEG) has clinical and prognostic importance after cardiac arrest (CA). Recently, interest in quantitative EEG (qEEG) analysis has grown. The qualitative effects of sedation on EEG are well known, but potentially confounding effects of sedatives on qEEG after anoxic injury are poorly characterized. We hypothesize that sedation increases suppression ratio (SR) and decreases alpha/delta ratio (ADR) and amplitude-integrated EEG (aEEG), and that the magnitude of sedation effects will be associated with outcome. Methods: We routinely monitor comatose post-arrest patients with EEG for 48–72 h. We included comatose EEG-monitored patients after CA who had protocolized daily sedation interruptions. We used Persyst v12 to quantify qEEG parameters and calculated medians for 10 min immediately prior to sedation interruption and for the last 5 min of interruption. We used paired t-tests to determine whether qEEG parameters changed with sedation cessation, and logistic regression to determine whether these changes predicted functional recovery or survival at discharge. Results: 78 subjects were included (median age 56, 65% male). Interruptions occurred a median duration of 34 h post-arrest and lasted a median duration of 60 min. Prior to interruption, higher aEEG predicted survival, while lower SRpredictedbothsurvival andfavorable outcome. During interruption, SRdecreased (p < 0.001), aEEG increased(p = 0.002), andADRdidnot change. Largerdecreases inSRpredicteddecreased survival (OR = 1.04 per percent change; 95% CI 1.00–1.09). Conclusion: Higher aEEG and lower SR predict survival after CA. Sedation alters aEEG and SR, but importantly does not appear to affect the relationship between these parameter values and outcome.

Conclusions

In comatose survivors of cardiac arrest, higher aEEG and lower SR values predict survival in comatose survivors of cardiac arrest. Thus far, sedation has remained a key confounding factor in cEEG research. We found that sedation alters aEEG and SR values, suggesting this should be accounted for in future studies. With the exception of suppression ratio, the qEEG changes attributable to sedation do not appear to be associated with clinical outcome.