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Burst Suppression: Causes and Effects on Mortality in Critical Illness.

Abstract：

BACKGROUND:Burst suppression in mechanically ventilated intensive care unit (ICU) patients is associated with increased mortality. However, the relative contributions of propofol use and critical illness itself to burst suppression; of burst suppression, propofol, and critical illness to mortality; and whether preventing burst suppression might reduce mortality, have not been quantified. METHODS:The dataset contains 471 adults from seven ICUs, after excluding anoxic encephalopathy due to cardiac arrest or intentional burst suppression for therapeutic reasons. We used multiple prediction and causal inference methods to estimate the effects connecting burst suppression, propofol, critical illness, and in-hospital mortality in an observational retrospective study. We also estimated the effects mediated by burst suppression. Sensitivity analysis was used to assess for unmeasured confounding. RESULTS:The expected outcomes in a "counterfactual" randomized controlled trial (cRCT) that assigned patients to mild versus severe illness are expected to show a difference in burst suppression burden of 39%, 95% CI [8-66]%, and in mortality of 35% [29-41]%. Assigning patients to maximal (100%) burst suppression burden is expected to increase mortality by 12% [7-17]% compared to 0% burden. Burst suppression mediates 10% [2-21]% of the effect of critical illness on mortality. A high cumulative propofol dose (1316 mg/kg) is expected to increase burst suppression burden by 6% [0.8-12]% compared to a low dose (284 mg/kg). Propofol exposure has no significant direct effect on mortality; its effect is entirely mediated through burst suppression. CONCLUSIONS:Our analysis clarifies how important factors contribute to mortality in ICU patients. Burst suppression appears to contribute to mortality but is primarily an effect of critical illness rather than iatrogenic use of propofol.

journal_name

Neurocrit Care

journal_title

Neurocritical care

authors

Hogan J,Sun H,Aboul Nour H,Jing J,Tabaeizadeh M,Shoukat M,Javed F,Kassa S,Edhi MM,Bordbar E,Gallagher J,Junior VM,Ghanta M,Shao YP,Akeju O,Cole AJ,Rosenthal ES,Zafar S,Westover MB

doi

10.1007/s12028-020-00932-4

subject

Has Abstract

pub_date

2020-10-01 00:00:00

pages

565-574

issue

eissn

1541-6933

issn

1556-0961

pii

10.1007/s12028-020-00932-4

journal_volume

pub_type

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Burst Suppression: Causes and Effects on Mortality in Critical Illness.