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A Novel Approach to Screen for Somatosensory Evoked Potentials in Critical Care

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Abstract

Background

Somatosensory evoked potentials (SSEPs) help prognostication, particularly in patients with diffuse brain injury. However, use of SSEP is limited in critical care. We propose a novel, low-cost approach allowing acquisition of screening SSEP using widely available intensive care unit (ICU) equipment, specifically a peripheral “train-of-four” stimulator and standard electroencephalograph.

Methods

The median nerve was stimulated using a train-of-four stimulator, and a standard 21-channel electroencephalograph was recorded to generate the screening SSEP. Generation of the SSEP was supported by visual inspection, univariate event-related potentials statistics, and a multivariate support vector machine (SVM) decoding algorithm. This approach was validated in 15 healthy volunteers and validated against standard SSEPs in 10 ICU patients. The ability of this approach to predict poor neurological outcome, defined as death, vegetative state, or severe disability at 6 months, was tested in an additional set of 39 ICU patients.

Results

In each of the healthy volunteers, both the univariate and the SVM methods reliably detected SSEP responses. In patients, when compared against the standard SSEP method, the univariate event-related potentials method matched in nine of ten patients (sensitivity = 94%, specificity = 100%), and the SVM had 100% sensitivity and specificity when compared with the standard method. For the 49 ICU patients, we performed both the univariate and the SVM methods: a bilateral absence of short latency responses (n = 8) predicted poor neurological outcome with 0% FPR (sensitivity = 21%, specificity = 100%).

Conclusions

Somatosensory evoked potentials can reliably be recorded using the proposed approach. Given the very good but slightly lower sensitivity of absent SSEPs in the proposed screening approach, confirmation of absent SSEP responses using standard SSEP recordings is advised.

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Author information

Author notes

  1. Aude Sangare, Benjamin Rohaut, Lionel Naccache and Jan Claassen contributed equally.

Authors and Affiliations

  1. Brain Institute, ICM, CNRS, Sorbonne Université, Inserm U1127, UMR 7225, Paris, France

    Aude Sangare, Benjamin Rohaut & Lionel Naccache

  2. Department of Neurophysiology, Pitié-Salpêtrière, Groupe Hospitalier Universitaire Assistance Publique–Hôpitaux de Paris Sorbonne Université, Paris, France

    Aude Sangare, Benjamin Rohaut, Alaina Borden, Julie Zyss & Lionel Naccache

  3. Sorbonne University, Paris, France

    Aude Sangare & Lionel Naccache

  4. Neurological Intensive Care Unit, Department of Neurology, Pitié-Salpêtrière, Groupe Hospitalier Universitaire Assistance Publique–Hôpitaux de Paris Sorbonne Université, Paris, France

    Benjamin Rohaut

  5. Department of Neurology, Columbia University, New York, NY, USA

    Benjamin Rohaut, Angela Velazquez, Kevin Doyle & Jan Claassen

  6. New York Presbyterian Hospital, New York, NY, USA

    Benjamin Rohaut & Jan Claassen

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  1. Aude Sangare
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Contributions

All authors conceived of and contributed to the design of the project, the interpretation of results, and the critical revision of the article. AS and BR performed data analyses and were responsible for primary drafting of the manuscript. The final manuscript was approved by all authors.

Corresponding author

Correspondence to Aude Sangare.

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Conflict of interest

The authors declare that they have no competing interests.

Ethical approval/informed consent

The study was approved for both patients and healthy volunteers by the local institutional review board (Consciousness Recovery Project with Outcomes IRB-AAAR3191 approval [12/07/2017]). Procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975. Written informed consent was obtained from patient surrogates and from the healthy volunteers, respectively; all patients who recovered consciousness were given the opportunity to withdraw from the study.

Source of support

This project was directly supported by a grant from the DANA foundation in aide of Dr Claassen. Additionally, Dr. Claassen reports funding from the NIH (R01 NS106014 and R03 NS112760) and the McDonnel Foundation. Dr. Rohaut received postdoctoral grants from Amicale des Anciens Internes des Hôpitaux de Paris and Syndicat des Chefs de Cliniques et Assistants des Hôpitaux de Paris, Assistance Publique–Hôpitaux de Paris, and the Philippe Foundation. This work was funded by ‘‘Institut National de la Sante´ et de la Recherche Médicale’’ and ‘‘Poste d’Accueil Inserm program’’ (Aude Sangare).

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Sangare, A., Rohaut, B., Borden, A. et al. A Novel Approach to Screen for Somatosensory Evoked Potentials in Critical Care. Neurocrit Care 40, 237–250 (2024). https://doi.org/10.1007/s12028-023-01710-8

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