Neurological Research ( IF 1.7 ) Pub Date : 2020-11-19 , DOI: 10.1080/01616412.2020.1849901 Vincent Legros 1, 2 , Bruno Mourvillier 2, 3 , Thierry Floch 1 , Quentin Candelier 4 , Jeremy Rosman 5 , Bruno Lafont 6 , Jean-Christophe Farkas 6 , Mathieu Bard 2, 4 , Lukshe Kanagaratnam 2, 7 , Philippe Mateu 5
ABSTRACT
Objectives: To demonstrate that a BRASS score≥ 3 at admission of intubated, ventilated and sedated patients is predictive of mortality
Methods: we have realized an Observational prospective multicenter study.
All Major patients without neurological history, admitted to ICU for a non-neurological cause, sedated and admitted under mechanical ventilation were included.
Results: One hundred and ten patients were included, the BRASS score as well as the FOUR and RASS scores were collected.
At day 28, patients with a BRASS score ≥ 3 had an excess mortality (OR 3.29 – CI 95% [1.42–7.63], p = 0.005) as well as day 90 (OR 2.65 – CI 95% [1.19–5.88], p = 0.02), without impact on the delirium measured by CAM-ICU (OR 1.8 – CI 95% [0.68–4.77], p = 0.023). After adjustment with SAPS II, FOUR and RASS, difference in mortality was not any more different.
It is also noted that patients with BRASS ≥ 3 are more sedated (RASS: −5 [−5 – −5] vs −4 [−5 – −3], p < 0.0001) and more comatose (FOUR: 2 [1–4] vs 6 [4–9], p < 0.0001), and have higher doses of midazolam (10 mg/h [5–15] vs 7.5 mg/h [5–10], p = 0.02) and sufentanil (20 μg/h [15–22.5] vs 10 [10–12.5], p = 0.01).
Conclusions: The early alteration of brainstem reflexes measured by the BRASS score was not independently predictable in terms of mortality in the non-neurological ICU patients, admitted under sedation and mechanical ventilation.
Trial registration: ClinicalTrials.gov Identifier: NCT03835091,Registered 8 February 2019 – prospectively registered, https://clinicaltrials.gov/ct2/show/NCT03835091
中文翻译:
在镇静危重患者中使用 BRASS 作为可预测的死亡率因素:BRASS-ICU
摘要
目的:证明插管、通气和镇静患者入院时 BRASS 评分≥ 3 可预测死亡率
方法:我们实现了一项观察性前瞻性多中心研究。
所有没有神经系统病史、因非神经系统原因入住 ICU、使用镇静剂并在机械通气下入院的主要患者都包括在内。
结果:共纳入110例患者,收集BRASS评分以及FOUR和RASS评分。
在第 28 天,BRASS 评分 ≥ 3 的患者死亡率过高(OR 3.29 – CI 95% [1.42–7.63],p = 0.005)以及第 90 天(OR 2.65 – CI 95% [1.19–5.88], p = 0.02),对 CAM-ICU 测量的谵妄没有影响(OR 1.8 – CI 95% [0.68–4.77],p = 0.023)。用 SAPS II、FOUR 和 RASS 调整后,死亡率的差异不再不同。
还应注意的是,BRASS ≥ 3 的患者镇静程度更高(RASS:-5 [-5 – -5] vs -4 [-5 – -3],p < 0.0001)和更多昏迷(4:2 [1- 4] vs 6 [4–9],p < 0.0001),并且具有更高剂量的咪达唑仑(10 mg/h [5–15] vs 7.5 mg/h [5–10],p = 0.02)和舒芬太尼(20 μg/h [15–22.5] 与 10 [10–12.5],p = 0.01)。
结论: BRASS 评分测量的脑干反射的早期改变不能独立预测非神经科 ICU 患者的死亡率,这些患者在镇静和机械通气下入院。
试验注册:ClinicalTrials.gov 标识符:NCT03835091,2019年 2 月 8 日注册——前瞻性注册,https ://clinicaltrials.gov/ct2/show/NCT03835091