• Sarah Benghanem, Alain Cariou, Jean-Luc Diehl, Angela Marchi, Julien Charpentier, Jean-Loup Augy, Caroline Hauw-Berlemont, Martine Gavaret, Frédéric Pène, Jean-Paul Mira, Tarek Sharshar, and Bertrand Hermann.
• Medical Intensive Care Unit, Cochin Hospital, Assistance Publique - Hôpitaux de Paris-Centre (APHP-Centre), Paris, France.
• Crit. Care Med. 2022 Jul 1; 50 (7): 110311151103-1115.

ObjectivesDescribe the prevalence of acute cerebral dysfunction and assess the prognostic value of an early clinical and electroencephalography (EEG) assessment in ICU COVID-19 patients.DesignProspective observational study.SettingTwo tertiary critical care units in Paris, France, between April and December 2020.PatientsAdult critically ill patients with COVID-19 acute respiratory distress syndrome.InterventionsNeurologic examination and EEG at two time points during the ICU stay, first under sedation and second 4-7 days after sedation discontinuation.Measurements And Main ResultsAssociation of EEG abnormalities (background reactivity, continuity, dominant frequency, and presence of paroxystic discharges) with day-28 mortality and neurologic outcomes (coma and delirium recovery). Fifty-two patients were included, mostly male (81%), median (interquartile range) age 68 years (56-74 yr). Delayed awakening was present in 68% of patients (median awakening time of 5 d [2-16 d]) and delirium in 74% of patients who awoke from coma (62% of mixed delirium, median duration of 5 d [3-8 d]). First, EEG background was slowed in the theta-delta range in 48 (93%) patients, discontinuous in 25 patients (48%), and nonreactive in 17 patients (33%). Bifrontal slow waves were observed in 17 patients (33%). Early nonreactive EEG was associated with lower day-28 ventilator-free days (0 vs 16; p = 0.025), coma-free days (6 vs 22; p = 0.006), delirium-free days (0 vs 17; p = 0.006), and higher mortality (41% vs 11%; p = 0.027), whereas discontinuous background was associated with lower ventilator-free days (0 vs 17; p = 0.010), coma-free days (1 vs 22; p < 0.001), delirium-free days (0 vs 17; p = 0.001), and higher mortality (40% vs 4%; p = 0.001), independently of sedation and analgesia.ConclusionsClinical and neurophysiologic cerebral dysfunction is frequent in COVID-19 ARDS patients. Early severe EEG abnormalities with nonreactive and/or discontinuous background activity are associated with delayed awakening, delirium, and day-28 mortality.Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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