• Camille Legouy, Laura Girard-Stein, Ruben Wanono, Etienne de Montmollin, Geoffroy Vellieux, Lila Bouadma, Claire Dupuis, Sonia Abid, Camille Vinclair, Stéphane Ruckly, Anny Rouvel-Tallec, Marie-Pia d'Ortho, Jean-François Timsit, and Romain Sonneville.
• Department of Intensive Care Medicine, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France.
• Crit. Care Med. 2021 Apr 1; 49 (4): e423-e432.

ContextDelayed awakening after sedation interruption is frequent in critically ill patients receiving mechanical ventilation.ObjectivesWe aimed to investigate the association of standard electroencephalography with mortality and command following in this setting.Design, Setting, And PatientsIn a single-center study, we retrospectively analyzed standard electroencephalography performed in consecutive mechanically ventilated patients remaining unresponsive (comatose/stuporous or unable to follow commands) after sedation interruption. Standard electroencephalography parameters (background activity, continuity, and reactivity) were reassessed by neurophysiologists, blinded to patients' outcome. Patients were categorized during follow-up into three groups based on their best examination as: 1) command following, 2) unresponsive, or 3) deceased. Cause-specific models were used to identify independent standard electroencephalography parameters associated with main outcomes, that is, mortality and command following. Follow-up was right-censored 30 days after standard electroencephalography.Measurements And Main ResultsMain standard electroencephalography parameters recorded in 121 unresponsive patients (median time between sedation interruption and standard electroencephalography: 2 d [interquartile range, 1-4 d]) consisted of a background frequency greater than 4 Hz in 71 (59%), a discontinuous background in 19 (16%), and a preserved reactivity in 98/120 (82%) patients. At 30 days, 66 patients (55%) were command following, nine (7%) were unresponsive, and 46 (38%) had died. In a multivariate analysis adjusted for nonneurologic organ failure, a reactive standard electroencephalography with a background frequency greater than 4 Hz was independently associated with a reduced risk of death (cause-specific hazard ratio, 0.38; CI 95%, 0.16-0.9). By contrast, none of the standard electroencephalography parameters were independently associated with command following. Sensitivity analyses conducted after exclusion of 29 patients with hypoxic brain injury revealed similar findings.ConclusionsIn patients remaining unresponsive after sedation interruption, a pattern consisting of a reactive standard electroencephalography with a background frequency greater than 4 Hz was associated with decreased odds of death. None of the standard electroencephalography parameters were independently associated with command following.Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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