• Morteza Salimi, Amir-Homayoun Javadi, Milad Nazari, Sobhan Bamdad, Farhad Tabasi, Tannaz Parsazadegan, Fahime Ayene, Maede Karimian, Leila Gholami-Mahtaj, Shahin Shadnia, Hamidreza Jamaati, Alireza Salimi, and Mohammad Reza Raoufy.
• Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
• Neuromodulation. 2022 Dec 1; 25 (8): 135113631351-1363.

ObjectivesComa state and loss of consciousness are associated with impaired brain activity, particularly gamma oscillations, that integrate functional connectivity in neural networks, including the default mode network (DMN). Mechanical ventilation (MV) in comatose patients can aggravate brain activity, which has decreased in coma, presumably because of diminished nasal airflow. Nasal airflow, known to drive functional neural oscillations, synchronizing distant brain networks activity, is eliminated by tracheal intubation and MV. Hence, we proposed that rhythmic nasal air puffing in mechanically ventilated comatose patients may promote brain activity and improve network connectivity.Materials And MethodsWe recorded electroencephalography (EEG) from 15 comatose patients (seven women) admitted to the intensive care unit because of opium poisoning and assessed the activity, complexity, and connectivity of the DMN before and during the nasal air-puff stimulation. Nasal cavity air puffing was done through a nasal cannula controlled by an electrical valve (open duration of 630 ms) with a frequency of 0.2 Hz (ie, 12 puff/min).ResultsOur analyses demonstrated that nasal air puffing enhanced the power of gamma oscillations (30-100 Hz) in the DMN. In addition, we found that the coherence and synchrony between DMN regions were increased during nasal air puffing. Recurrence quantification and fractal dimension analyses revealed that EEG global complexity and irregularity, typically seen in wakefulness and conscious state, increased during rhythmic nasal air puffing.ConclusionsRhythmic nasal air puffing, as a noninvasive brain stimulation method, opens a new window to modifying the brain connectivity integration in comatose patients. This approach may potentially influence comatose patients' outcomes by increasing brain reactivity and network connectivity.Copyright © 2021 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.

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