Background Deep sedation may hamper the detection of neurological deterioration in brain-injured patients. Impaired brainstem reflexes within the first 24 h of deep sedation are associated with increased mortality in non-brain-injured patients. Our objective was to confirm this association in brain-injured patients. Methods This was an observational prospective multicenter cohort study involving four neuro-intensive care units. We included acute brain-injured patients requiring deep sedation, defined by a Richmond Assessment Sedation Scale (RASS) < −3. Neurological assessment was performed at day 1 and included pupillary diameter, pupillary light, corneal and cough reflexes, and grimace and motor response to noxious stimuli. Pre-sedation Glasgow Coma Scale (GCS) and Simplified Acute Physiology Score (SAPS-II) were collected, as well as the cause of death in the Intensive Care Unit (ICU). Results A total of 137 brain-injured patients were recruited, including 70 (51%) traumatic brain-injured patients, 40 (29%) vascular (subarachnoid hemorrhage or intracerebral hemorrhage). Thirty patients (22%) died in the ICU. At day 1, the corneal (OR 2.69, p = 0.034) and cough reflexes (OR 5.12, p = 0.0003) were more frequently abolished in patients that died in the ICU. In a multivariate analysis, abolished cough reflex was associated with ICU mortality after adjustment to pre-sedation GCS, SAPS-II, RASS (OR: 5.19, 95% CI [1.92–14.1], p = 0.001) or dose of sedatives (OR: 8.89, 95% CI [2.64–30.0], p = 0.0004). Conclusion Early (day 1) cough reflex abolition is an independent predictor of mortality in deeply sedated brain-injured patients. Abolished cough reflex likely reflects a brainstem dysfunction that might result from the combination of primary and secondary neuro-inflammatory cerebral insults revealed and/or worsened by sedation.

中文翻译：

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早期消除咳嗽反射可预测深度镇静脑损伤患者的死亡率

背景 深度镇静可能会妨碍脑损伤患者神经功能恶化的检测。深度镇静最初 24 小时内脑干反射受损与非脑损伤患者死亡率增加有关。我们的目标是在脑损伤患者中证实这种关联。方法 这是一项涉及四个神经重症监护病房的观察性前瞻性多中心队列研究。我们纳入了需要深度镇静的急性脑损伤患者，由里士满镇静评估量表 (RASS) < -3 定义。在第 1 天进行神经系统评估，包括瞳孔直径、瞳孔光、角膜和咳嗽反射，以及对有害刺激的鬼脸和运动反应。收集镇静前格拉斯哥昏迷量表（GCS）和简化急性生理评分（SAPS-II），以及重症监护病房（ICU）的死因。结果共招募脑损伤患者137例，其中颅脑外伤患者70例（51%），血管（蛛网膜下腔出血或脑出血）40例（29%）。30 名患者 (22%) 死于 ICU。在第 1 天，死于 ICU 的患者的角膜反射（OR 2.69，p = 0.034）和咳嗽反射（OR 5.12，p = 0.0003）更频繁地消失。在一项多变量分析中，在调整镇静前 GCS、SAPS-II、RASS（OR：5.19，95% CI [1.92-14.1]，p = 0.001）或镇静剂剂量（OR : 8.89, 95% CI [2.64–30.0], p = 0.0004)。结论 早期（第 1 天）咳嗽反射消除是深度镇静脑损伤患者死亡率的独立预测因素。