Investigaciones electrofisiológicas de la función del cerebro en coma, en pacientes en estado vegetativo y con mínima conciencia.
Electrophysiological investigations of brain function in coma, vegetative and minimally conscious patients.
Lehembre R, Gosseries O, Lugo Z, Jedidi Z, Chatelle C, Sadzot B, Laureys S, Noirhomme Q.
Coma Science Group, Cyclotron Research Centre, University of Liège, Belgium. Email: remy.lehembre@ulg.ac.be.
Arch Ital Biol. 2012 Jun;150(2-3):122-39. doi: 10.4449/aib.v150i2.1374.
Abstract
Electroencephalographic activity in the context of disorders of consciousness is a swiss knife like tool that can evaluate different aspects of cognitive residual function, detect consciousness and provide a mean to communicate with the outside world without using muscular channels. Standard recordings in the neurological department offer a first global view of the electrogenesis of a patient and can spot abnormal epileptiform activity and therefore guide treatment. Although visual patterns have a prognosis value, they are not sufficient to provide a diagnosis between vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) patients. Quantitative electroencephalography (qEEG) processes the data and retrieves features, not visible on the raw traces, which can then be classified. Current results using qEEG show that MCS can be differentiated from VS/UWS patients at the group level. Event Related Potentials (ERP) are triggered by varying stimuli and reflect the time course of information processing related to the stimuli from low-level peripheral receptive structures to high-order associative cortices. It is hence possible to assess auditory, visual, or emotive pathways. Different stimuli elicit positive or negative components with different time signatures. The presence of these components when observed in passive paradigms is usually a sign of good prognosis but it cannot differentiate VS/UWS and MCS patients. Recently, researchers have developed active paradigms showing that the amplitude of the component is modulated when the subject's attention is focused on a task during stimulus presentation. Hence significant differences between ERPs of a patient in a passive compared to an active paradigm can be a proof of consciousness. An EEG-based brain-computer interface (BCI) can then be tested to provide the patient with a communication tool. BCIs have considerably improved the past two decades. However they are not easily adaptable to comatose patients as they can have visual or auditory impairments or different lesions affecting their EEG signal. Future progress will require large databases of resting state-EEG and ERPs experiment of patients of different etiologies. This will allow the identification of specific patterns related to the diagnostic of consciousness. Standardized procedures in the use of BCIs will also be needed to find the most suited technique for each individual patient.
http://www.architalbiol.org/aib/article/view/150122/23165873
Fiabilidad y validez de la herramienta del comportamiento facial, piernas, actividad, y llanto en la en la evaluación del dolor agudo en pacientes en estado crítico
Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients.
Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S.
University of Michigan Health System, Ann Arbor, USA. terriv@umich.edu
Am J Crit Care. 2010 Jan;19(1):55-61; quiz 62. doi: 10.4037/ajcc2010624.
Abstract
BACKGROUND: Few investigators have evaluated pain assessment tools in the critical care setting. OBJECTIVE: To evaluate the reliability and validity of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale in assessing pain in critically ill adults and children unable to self-report pain. METHODS: Three nurses simultaneously, but independently, observed and scored pain behaviors twice in 29 critically ill adults and 8 children: before administration of an analgesic or during a painful procedure, and 15 to 30 minutes after the administration or procedure. Two nurses used the FLACC scale, the third used either the Checklist of Nonverbal Pain Indicators (for adults) or the COMFORT scale (for children). RESULTS: For 73 observations, FLACC scores correlated highly with the other 2 scores (rho = 0.963 and 0.849, respectively), supporting criterion validity. Significant decreases in FLACC scores after analgesia (or at rest) supported construct validity of the tool (mean, 5.27; SD, 2.3 vs mean, 0.52; SD, 1.1; P < .001). Exact agreement and kappa statistics, as well as intraclass correlation coefficients (0.67-0.95), support excellent interrater reliability of the tool. Internal consistency was excellent; the Cronbach alpha was 0.882 when all items were included.CONCLUSIONS: Although similar in content to other behavioral pain scales, the FLACC can be used across populations of patients and settings, and the scores are comparable to those of the commonly used 0-to-10 number rating scale.
http://ajcc.aacnjournals.org/content/19/1/55.full.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Electrophysiological investigations of brain function in coma, vegetative and minimally conscious patients.
Lehembre R, Gosseries O, Lugo Z, Jedidi Z, Chatelle C, Sadzot B, Laureys S, Noirhomme Q.
Coma Science Group, Cyclotron Research Centre, University of Liège, Belgium. Email: remy.lehembre@ulg.ac.be.
Arch Ital Biol. 2012 Jun;150(2-3):122-39. doi: 10.4449/aib.v150i2.1374.
Abstract
Electroencephalographic activity in the context of disorders of consciousness is a swiss knife like tool that can evaluate different aspects of cognitive residual function, detect consciousness and provide a mean to communicate with the outside world without using muscular channels. Standard recordings in the neurological department offer a first global view of the electrogenesis of a patient and can spot abnormal epileptiform activity and therefore guide treatment. Although visual patterns have a prognosis value, they are not sufficient to provide a diagnosis between vegetative state/unresponsive wakefulness syndrome (VS/UWS) and minimally conscious state (MCS) patients. Quantitative electroencephalography (qEEG) processes the data and retrieves features, not visible on the raw traces, which can then be classified. Current results using qEEG show that MCS can be differentiated from VS/UWS patients at the group level. Event Related Potentials (ERP) are triggered by varying stimuli and reflect the time course of information processing related to the stimuli from low-level peripheral receptive structures to high-order associative cortices. It is hence possible to assess auditory, visual, or emotive pathways. Different stimuli elicit positive or negative components with different time signatures. The presence of these components when observed in passive paradigms is usually a sign of good prognosis but it cannot differentiate VS/UWS and MCS patients. Recently, researchers have developed active paradigms showing that the amplitude of the component is modulated when the subject's attention is focused on a task during stimulus presentation. Hence significant differences between ERPs of a patient in a passive compared to an active paradigm can be a proof of consciousness. An EEG-based brain-computer interface (BCI) can then be tested to provide the patient with a communication tool. BCIs have considerably improved the past two decades. However they are not easily adaptable to comatose patients as they can have visual or auditory impairments or different lesions affecting their EEG signal. Future progress will require large databases of resting state-EEG and ERPs experiment of patients of different etiologies. This will allow the identification of specific patterns related to the diagnostic of consciousness. Standardized procedures in the use of BCIs will also be needed to find the most suited technique for each individual patient.
http://www.architalbiol.org/aib/article/view/150122/23165873
Fiabilidad y validez de la herramienta del comportamiento facial, piernas, actividad, y llanto en la en la evaluación del dolor agudo en pacientes en estado crítico
Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients.
Voepel-Lewis T, Zanotti J, Dammeyer JA, Merkel S.
University of Michigan Health System, Ann Arbor, USA. terriv@umich.edu
Am J Crit Care. 2010 Jan;19(1):55-61; quiz 62. doi: 10.4037/ajcc2010624.
Abstract
BACKGROUND: Few investigators have evaluated pain assessment tools in the critical care setting. OBJECTIVE: To evaluate the reliability and validity of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale in assessing pain in critically ill adults and children unable to self-report pain. METHODS: Three nurses simultaneously, but independently, observed and scored pain behaviors twice in 29 critically ill adults and 8 children: before administration of an analgesic or during a painful procedure, and 15 to 30 minutes after the administration or procedure. Two nurses used the FLACC scale, the third used either the Checklist of Nonverbal Pain Indicators (for adults) or the COMFORT scale (for children). RESULTS: For 73 observations, FLACC scores correlated highly with the other 2 scores (rho = 0.963 and 0.849, respectively), supporting criterion validity. Significant decreases in FLACC scores after analgesia (or at rest) supported construct validity of the tool (mean, 5.27; SD, 2.3 vs mean, 0.52; SD, 1.1; P < .001). Exact agreement and kappa statistics, as well as intraclass correlation coefficients (0.67-0.95), support excellent interrater reliability of the tool. Internal consistency was excellent; the Cronbach alpha was 0.882 when all items were included.CONCLUSIONS: Although similar in content to other behavioral pain scales, the FLACC can be used across populations of patients and settings, and the scores are comparable to those of the commonly used 0-to-10 number rating scale.
http://ajcc.aacnjournals.org/content/19/1/55.full.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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