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

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