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A Novel Approach to Screen for Somatosensory Evoked Potentials in Critical Care.
Sangare, Aude; Rohaut, Benjamin; Borden, Alaina; Zyss, Julie; Velazquez, Angela; Doyle, Kevin; Naccache, Lionel; Claassen, Jan.
Afiliación
  • Sangare A; Brain Institute, ICM, CNRS, Sorbonne Université, Inserm U1127, UMR 7225, Paris, France. aude.sangare@aphp.fr.
  • Rohaut B; Department of Neurophysiology, Pitié-Salpêtrière, Groupe Hospitalier Universitaire Assistance Publique-Hôpitaux de Paris Sorbonne Université, Paris, France. aude.sangare@aphp.fr.
  • Borden A; Sorbonne University, Paris, France. aude.sangare@aphp.fr.
  • Zyss J; Brain Institute, ICM, CNRS, Sorbonne Université, Inserm U1127, UMR 7225, Paris, France.
  • Velazquez A; Department of Neurophysiology, Pitié-Salpêtrière, Groupe Hospitalier Universitaire Assistance Publique-Hôpitaux de Paris Sorbonne Université, Paris, France.
  • Doyle K; Neurological Intensive Care Unit, Department of Neurology, Pitié-Salpêtrière, Groupe Hospitalier Universitaire Assistance Publique-Hôpitaux de Paris Sorbonne Université, Paris, France.
  • Naccache L; Department of Neurology, Columbia University, New York, NY, USA.
  • Claassen J; New York Presbyterian Hospital, New York, NY, USA.
Neurocrit Care ; 40(1): 237-250, 2024 Feb.
Article en En | MEDLINE | ID: mdl-36991177
ABSTRACT

BACKGROUND:

Somatosensory evoked potentials (SSEPs) help prognostication, particularly in patients with diffuse brain injury. However, use of SSEP is limited in critical care. We propose a novel, low-cost approach allowing acquisition of screening SSEP using widely available intensive care unit (ICU) equipment, specifically a peripheral "train-of-four" stimulator and standard electroencephalograph.

METHODS:

The median nerve was stimulated using a train-of-four stimulator, and a standard 21-channel electroencephalograph was recorded to generate the screening SSEP. Generation of the SSEP was supported by visual inspection, univariate event-related potentials statistics, and a multivariate support vector machine (SVM) decoding algorithm. This approach was validated in 15 healthy volunteers and validated against standard SSEPs in 10 ICU patients. The ability of this approach to predict poor neurological outcome, defined as death, vegetative state, or severe disability at 6 months, was tested in an additional set of 39 ICU patients.

RESULTS:

In each of the healthy volunteers, both the univariate and the SVM methods reliably detected SSEP responses. In patients, when compared against the standard SSEP method, the univariate event-related potentials method matched in nine of ten patients (sensitivity = 94%, specificity = 100%), and the SVM had 100% sensitivity and specificity when compared with the standard method. For the 49 ICU patients, we performed both the univariate and the SVM

methods:

a bilateral absence of short latency responses (n = 8) predicted poor neurological outcome with 0% FPR (sensitivity = 21%, specificity = 100%).

CONCLUSIONS:

Somatosensory evoked potentials can reliably be recorded using the proposed approach. Given the very good but slightly lower sensitivity of absent SSEPs in the proposed screening approach, confirmation of absent SSEP responses using standard SSEP recordings is advised.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Potenciales Evocados Somatosensoriales / Nervio Mediano Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: Neurocrit Care Asunto de la revista: NEUROLOGIA / TERAPIA INTENSIVA Año: 2024 Tipo del documento: Article País de afiliación: Francia

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Potenciales Evocados Somatosensoriales / Nervio Mediano Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: Neurocrit Care Asunto de la revista: NEUROLOGIA / TERAPIA INTENSIVA Año: 2024 Tipo del documento: Article País de afiliación: Francia