Data_Sheet_1_Sedation-Induced Burst Suppression Predicts Positive Outcome Following Traumatic Brain Injury.docx

While electroencephalogram (EEG) burst-suppression is often induced therapeutically using sedatives in the intensive care unit (ICU), there is hitherto no evidence with respect to its association to outcome in moderate-to-severe neurological patients. We examined the relationship between sedation-induced burst-suppression (SIBS) and outcome at hospital discharge and at 6-month follow up in patients surviving moderate-to-severe traumatic brain injury (TBI). For each of 32 patients recovering from coma after moderate-to-severe TBI, we measured the EEG burst suppression ratio (BSR) during periods of low responsiveness as assessed with the Glasgow Coma Scale (GCS). The maximum BSR was then used to predict the Glasgow Outcome Scale extended (GOSe) at discharge and at 6 months post-injury. A multi-model inference approach was used to assess the combination of predictors that best fit the outcome data. We found that BSR was positively associated with outcomes at 6 months (P = 0.022) but did not predict outcomes at discharge. A mediation analysis found no evidence that BSR mediates the effects of barbiturates or propofol on outcomes. Our results provide initial observational evidence that burst suppression may be neuroprotective in acute patients with TBI etiologies. SIBS may thus be useful in the ICU as a prognostic biomarker.

尽管重症监护病房（intensive care unit, ICU）中常通过镇静药物诱导脑电图（electroencephalogram, EEG）爆发抑制，但迄今为止尚无关于其与中重度神经系统疾病患者预后相关性的研究证据。本研究针对中重度创伤性脑损伤（traumatic brain injury, TBI）存活患者，探讨了镇静诱导爆发抑制（sedation-induced burst-suppression, SIBS）与患者出院时及6个月随访时的预后之间的关联。本研究纳入32例中重度TBI后昏迷苏醒的患者，采用格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）评估患者反应低下阶段的脑电图爆发抑制比（EEG burst suppression ratio, BSR），并以最大BSR预测患者出院时及伤后6个月的扩展格拉斯哥结局量表（Glasgow Outcome Scale extended, GOSe）评分。研究采用多模型推断方法，筛选出最适配预后数据的预测因子组合。结果显示，BSR与患者6个月时的预后呈正相关（P=0.022），但无法预测患者出院时的预后。中介分析未发现BSR介导巴比妥类药物或丙泊酚对预后产生影响的证据。本研究结果提供了初步的观察性证据，表明爆发抑制可能对创伤性脑损伤病因的急性患者具有神经保护作用。因此，SIBS或可在重症监护病房中作为预后生物标志物发挥应用价值。