Covert Brain Complexity in the Intensive Care Unit

Read the full article See related articles

Listed in

This article is not in any list yet, why not save it to one of your lists.
Log in to save this article

Abstract

Early detection of consciousness in critically ill patients with severe brain injuries has a profound impact on prognostication and decisions about whether to continue or limit life-sustaining therapy. The current state-of-the-art protocol to detect signs of consciousness includes standardized behavioral assessments, task-based functional magnetic resonance imaging (fMRI), and task-based electroencephalography (EEG). However, this approach has limited diagnostic sensitivity because auditory pathways may be disrupted, and conscious patients may lack attention, language, or other cognitive functions required to perform a task. Transcranial magnetic stimulation EEG (TMS-EEG) has the potential to overcome these limitations by directly perturbing the cerebral cortex to compute the perturbational complexity index, a neural correlate of consciousness. To date, TMS-EEG studies have focused on patients in the subacute or chronic stage of recovery from severe brain injury. Here, we report the proof-of-concept application of TMS-EEG for a critically ill patient in the acute stage of brain injury recovery. We show that TMS-EEG is feasible to perform as part of a multimodal protocol in the intensive care unit and that TMS-EEG may detect signs of consciousness that elude current state-of-the-art assessments.

Article activity feed