Dataset Information

Sleep in neurointensive care patients, and patients after brain tumor surgery.

ABSTRACT:

Background

Severely brain injured patients treated in the neuro intensive care unit (NICU) are usually sedated. Sedation may affect not only the ability to sleep, but also the EEG rhythms used to identify sleep.

Aim

The aims were: To study if sleep patterns could be identified in the severely brain injured and sedated patients in the NICUTo study if sleep patterns could be identified in patients the night after brain tumor surgery in the neurointermediate care unit (NIMCU)To search for risk factors for not being able to sleep after brain tumor surgery.

Study design

Two populations were included; one with patients affected by severe brain injury and one with patients who had undergone planned brain tumor surgery. This was a quantitative observational study using EEG. Eligible neurointensive care patients for this study had to be suffering from a neurosurgical condition (for example subarachnoid haemorrhage, acute subdural hematoma, intracerebral haemorrhage and meningitis), have affected consciousness and age over 18 years. Thirty-seven patients were included from NICU. Ninety-eight patients, with a suspected glioma (WHO grade II-IV) planned for surgery were also included.

Results

Neuro intensive care patients, sedated and treated in ventilator, showed no EEG sleep patterns at all. After brain tumor surgery, sleep occurred in 74% of the patients, despite frequent wake-up tests. The patients with sleep patterns were on average 8 years younger, p = 0.03.

Conclusions

Patients with severe brain injury are at risk of having no sleep when treated at the NICU, whereas after brain tumor surgery, sleep occurs in three-fourths of the patients. Further studies and new methods are warranted to identify sleep and investigate how the loss of sleep affects these patients and how sleep disturbances can be managed.

SUBMITTER: Nyholm L

PROVIDER: S-EPMC10289440 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Publications

Sleep in neurointensive care patients, and patients after brain tumor surgery.

Nyholm Lena L Zetterling Maria M Elf Kristin K

PloS one 20230623 6

<h4>Background</h4>Severely brain injured patients treated in the neuro intensive care unit (NICU) are usually sedated. Sedation may affect not only the ability to sleep, but also the EEG rhythms used to identify sleep.<h4>Aim</h4>The aims were: To study if sleep patterns could be identified in the severely brain injured and sedated patients in the NICUTo study if sleep patterns could be identified in patients the night after brain tumor surgery in the neurointermediate care unit (NIMCU)To searc ...[more]

PMID: 37352254

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Project description:BackgroundPatients with traumatic brain injury (TBI) with large contusions make up a specific TBI subtype. Because of the risk of brain edema worsening, elevated cerebral perfusion pressure (CPP) may be particularly dangerous. The pressure reactivity index (PRx) and optimal cerebral perfusion pressure (CPPopt) are new promising perfusion targets based on cerebral autoregulation, but they reflect the global brain state and may be less valid in patients with predominant focal lesions. In this study, we aimed to investigate if patients with TBI with significant contusions exhibited a different association between PRx, CPP, and CPPopt in relation to functional outcome compared to those with small/no contusions.MethodsThis observational study included 385 patients with moderate to severe TBI treated at a neurointensive care unit in Uppsala, Sweden. The patients were classified into two groups: (1) significant contusions (> 10 mL) and (2) small/no contusions (but with extra-axial or diffuse injuries). The percentage of good monitoring time (%GMT) with intracranial pressure > 20 mm Hg; PRx > 0.30; CPP < 60 mm Hg, within 60-70 mm Hg, or > 70 mm Hg; and ΔCPPopt less than - 5 mm Hg, ± 5 mm Hg, or > 5 mm Hg was calculated. Outcome (Glasgow Outcome Scale-Extended) was assessed after 6 months.ResultsAmong the 120 (31%) patients with significant contusions, a lower %GMT with CPP between 60 and 70 mm Hg was independently associated with unfavorable outcome. The %GMTs with PRx and ΔCPPopt ± 5 mm Hg were not independently associated with outcome. Among the 265 (69%) patients with small/no contusions, a higher %GMT of PRx > 0.30 and a lower %GMT of ΔCPPopt ± 5 mm Hg were independently associated with unfavorable outcome.ConclusionsIn patients with TBI with significant contusions, CPP within 60-70 mm Hg may improve outcome. PRx and CPPopt, which reflect global cerebral pressure autoregulation, may be useful in patients with TBI without significant focal brain lesions but seem less valid for those with large contusions. However, this was an observational, hypothesis-generating study; our findings need to be validated in prospective studies before translating them into clinical practice.

Project description:BackgroundThe study aimed to compare the difference in long-term mortality in patients with moderate to severe traumatic brain injury (TBI) receiving Early interdisciplinary rehabilitation (EIR) in our Neurointensive Care Unit (NICU) to patients being discharged from NICU without EIR.MethodsRetrospective observational cohort study of adults aged 18-67 years with moderate to severe TBI (Glasgow Coma Scale 3-14), admitted to the NICU for >72 h from 2010 to 2022. We analyzed mortality differences from the start of follow-up (cessation of sedation in the Standard of care (SC) group and start of EIR in the EIR group) until 31.12.2023, using inverse probability of treatment weighted Cox proportional hazard models and Kaplan-Meier survival curves. Adjustments using weights were made for various variables, including age, days from injury to follow-up start, sociodemographic factors, comorbidities, and injury characteristics.ResultsA total of 698 patients were included, 461 received EIR and 237 SC. Sixty-three (27%) patients in the SC group and 59 (13%) patients in the EIR group died by the end of follow-up. In covariate-adjusted Kaplan-Meier curves, estimated survival at the end of follow-up was 56% (95% CI 0.36, 0.69) for the SC group and 74% (95% CI 0.58, 0.83) for the EIR group. Both groups had the highest mortality rate within 30 days. The mortality in the EIR group was significantly lower with an adjusted hazard ratio (HR) at 30 days of 0.57 (95% CI 0.37, 0.87) p-value = .010, and at the end of follow-up of 0.56 (95% CI 0.36, 0.89), p-value = .015.ConclusionsPatients receiving EIR had better long-term survival, with both groups experiencing the highest mortality rate early on. Early rehabilitation in NICU may play an important role in preventing and identifying medical complications and should be explored as a potential mechanism in future prospective trials.Editorial commentNeurorehabilitation following intensive care for traumatic brain injury is important to help the patients regain function. However, it is uncertain whether survival is improved by the initiation of interdisciplinary rehabilitation already during neurointensive care, consisting of mobilization and training activities of daily living as well as swallowing. This study compared long-term survival in a retrospective cohort of patients with moderate to severe traumatic brain injury and found that those receiving early rehabilitation had a higher long-term survival, which persisted for up to 13 years but was mainly due to improved survival during the first 3 months. Whether this is due to physiological effects or an increased enthusiasm among healthcare providers to continue active treatment is unknown and should be further explored.

Dataset Information

Sleep in neurointensive care patients, and patients after brain tumor surgery.

Background

Aim

Study design

Results

Conclusions

Publications

Sleep in neurointensive care patients, and patients after brain tumor surgery.

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