Intensive Care Medicine

, Volume 40, Issue 4, pp 484–495 | Cite as

Neurological examination of critically ill patients: a pragmatic approach. Report of an ESICM expert panel

  • Tarek Sharshar
  • Giuseppe Citerio
  • Peter J. D. Andrews
  • Arturo Chieregato
  • Nicola Latronico
  • David K. Menon
  • Louis Puybasset
  • Claudio Sandroni
  • Robert D. Stevens
Conference Reports and Expert Panel

Abstract

Objective

Many patients admitted to the intensive care unit (ICU) have pre-existing or acquired neurological disorders which significantly affect their short-term and long-term outcomes. The ESICM NeuroIntensive Care Section convened an expert panel to establish a pragmatic approach to neurological examination (NE) of the critically ill patient.

Methods

The group conducted a comprehensive review of published studies on the NE of patients with coma, delirium, seizures and neuromuscular weakness in critically ill patients. Quality of data was rated as high, moderate, low, or very low, and final recommendations as strong, weak, or best practice.

Summary and Conclusions

The group made the following recommendations: (1) NE should be performed in all patients admitted to ICUs; (2) NE should include an assessment of consciousness and cognition, brainstem function, and motor function; (3) sedation should be managed to maximize the clinical detection of neurological dysfunction, except in patients with reduced intracranial compliance in whom withdrawal of sedation may be deleterious; (4) the need for additional tests, including neurophysiological and neuroradiological investigations, should be guided by the NE; (5) selected features of the NE have prognostic value which should be considered in well-defined patient populations.

Keywords

Coma Neurological examination Critical illness Sedation Delirium Neuroimaging 

References

  1. 1.
    Claassen J, Taccone FS, Horn P, Holtkamp M, Stocchetti N, Oddo M (2013) Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med. doi:10.1007/s00134-013-2938-4 Google Scholar
  2. 2.
    Ali NA, O’Brien JM Jr, Hoffmann SP, Phillips G, Garland A, Finley JC, Almoosa K, Hejal R, Wolf KM, Lemeshow S, Connors AF Jr, Marsh CB (2008) Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med 178:261–268PubMedCrossRefGoogle Scholar
  3. 3.
    Bastos PG, Sun X, Wagner DP, Wu AW, Knaus WA (1993) Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: findings from the Acute Physiology and Chronic Health Evaluation III study. Crit Care Med 21:1459–1465PubMedCrossRefGoogle Scholar
  4. 4.
    Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y (2001) Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med 27:859–864PubMedCrossRefGoogle Scholar
  5. 5.
    De Jonghe B, Bastuji-Garin S, Durand MC, Malissin I, Rodrigues P, Cerf C, Outin H, Sharshar T (2007) Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med 35:2007–2015PubMedCrossRefGoogle Scholar
  6. 6.
    De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, Cerf C, Renaud E, Mesrati F, Carlet J, Raphael JC, Outin H, Bastuji-Garin S (2002) Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 288:2859–2867PubMedCrossRefGoogle Scholar
  7. 7.
    Ely EW, Shintani A, Truman B, Speroff T, Gordon SM, Harrell FE Jr, Inouye SK, Bernard GR, Dittus RS (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753–1762PubMedCrossRefGoogle Scholar
  8. 8.
    Oddo M, Carrera E, Claassen J, Mayer SA, Hirsch LJ (2009) Continuous electroencephalography in the medical intensive care unit. Crit Care Med 37:2051–2056PubMedCrossRefGoogle Scholar
  9. 9.
    Sharshar T, Bastuji-Garin S, Stevens RD, Durand MC, Malissin I, Rodriguez P, Cerf C, Outin H, De Jonghe B (2009) Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality. Crit Care Med 37:3047–3053PubMedCrossRefGoogle Scholar
  10. 10.
    Samaniego EA, Mlynash M, Caulfield AF, Eyngorn I, Wijman CA (2011) Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia. Neurocrit Care 15:113–119PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Levy DE, Bates D, Caronna JJ, Cartlidge NE, Knill-Jones RP, Lapinski RH, Singer BH, Shaw DA, Plum F (1981) Prognosis in nontraumatic coma. Ann Intern Med 94:293–301PubMedCrossRefGoogle Scholar
  12. 12.
    Sharshar T, Porcher R, Siami S, Rohaut B, Bailly-Salin J, Hopkinson NS, Clair B, Guidoux C, Iacobone E, Sonneville R, Polito A, Aboab J, Gaudry S, Morla O, Amouyal G, Azuar J, Allary J, Vieillard-Baron A, Wolff M, Cariou A, Annane D (2011) Brainstem responses can predict death and delirium in sedated patients in intensive care unit. Crit Care Med 39:1960–1967PubMedCrossRefGoogle Scholar
  13. 13.
    Haenggi M, Blum S, Brechbuehl R, Brunello A, Jakob S, Takala J (2013) Effect of sedation level on the prevalence of delirium when assessed with CAM-ICU and ICDSC. Intensive Care Med 39:2171–2179PubMedCrossRefGoogle Scholar
  14. 14.
    Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, Dittus R (2001) Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 286:2703–2710PubMedCrossRefGoogle Scholar
  15. 15.
    Plum F, Posner JB (1981) The diagnosis of stupor and coma. Oford University Press, New York, pp 394–447Google Scholar
  16. 16.
    Kleyweg RP, van der Meche FG, Schmitz PI (1991) Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain–Barre syndrome. Muscle Nerve 14:1103–1109PubMedCrossRefGoogle Scholar
  17. 17.
    Teasdale G, Jennett B (1974) Assessment of coma and impaired consciousness. A practical scale. Lancet 2:81–84PubMedCrossRefGoogle Scholar
  18. 18.
    Wijdicks EF, Bamlet WR, Maramattom BV, Manno EM, McClelland RL (2005) Validation of a new coma scale: the FOUR score. Ann Neurol 58:585–593PubMedCrossRefGoogle Scholar
  19. 19.
    Bouwes A, Binnekade JM, Kuiper MA, Bosch FH, Zandstra DF, Toornvliet AC, Biemond HS, Kors BM, Koelman JH, Verbeek MM, Weinstein HC, Hijdra A, Horn J (2012) Prognosis of coma after therapeutic hypothermia: a prospective cohort study. Ann Neurol 71:206–212PubMedCrossRefGoogle Scholar
  20. 20.
    Kamps MJ, Horn J, Oddo M, Fugate JE, Storm C, Cronberg T, Wijman CA, Wu O, Binnekade JM, Hoedemaekers CW (2013) Prognostication of neurologic outcome in cardiac arrest patients after mild therapeutic hypothermia: a meta-analysis of the current literature. Intensive Care Med 39:1671–1682PubMedCrossRefGoogle Scholar
  21. 21.
    Bleck TP, Smith MC, Pierre-Louis SJ, Jares JJ, Murray J, Hansen CA (1993) Neurologic complications of critical medical illnesses. Crit Care Med 21:98–103PubMedCrossRefGoogle Scholar
  22. 22.
    Razvi SS, Bone I (2003) Neurological consultations in the medical intensive care unit. J Neurol Neurosurg Psychiatry 74(Suppl 3):iii16–iii23PubMedCentralPubMedGoogle Scholar
  23. 23.
    Vosylius S, Sipylaite J, Ivaskevicius J (2005) Determinants of outcome in elderly patients admitted to the intensive care unit. Age Ageing 34:157–162PubMedCrossRefGoogle Scholar
  24. 24.
    Shehabi Y, Chan L, Kadiman S, Alias A, Ismail WN, Tan MA, Khoo TM, Ali SB, Saman MA, Shaltut A, Tan CC, Yong CY, Bailey M, Sedation Practice in Intensive Care (SPICE) E, Study Group investigators (2013) Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study. Intensive Care Med 39:910–918PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Leijten FS, Harinck-de Weerd JE, Poortvliet DC, de Weerd AW (1995) The role of polyneuropathy in motor convalescence after prolonged mechanical ventilation. JAMA 274:1221–1225PubMedCrossRefGoogle Scholar
  26. 26.
    Girard TD, Jackson JC, Pandharipande PP, Pun BT, Thompson JL, Shintani AK, Gordon SM, Canonico AE, Dittus RS, Bernard GR, Ely EW (2010) Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med 38:1513–1520PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Iwashyna TJ, Ely EW, Smith DM, Langa KM (2010) Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 304:1787–1794PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes CG, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese S, Canonico A, Hopkins RO, Bernard GR, Dittus RS, Ely EW, BRAIN-ICU Study Investigators (2013) Long-term cognitive impairment after critical illness. N Engl J Med 369:1306–1316PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–1477PubMedCrossRefGoogle Scholar
  30. 30.
    Mehta S, Burry L, Cook D, Fergusson D, Steinberg M, Granton J, Herridge M, Ferguson N, Devlin J, Tanios M, Dodek P, Fowler R, Burns K, Jacka M, Olafson K, Skrobik Y, Hebert P, Sabri E, Meade M, Investigators S, Canadian Critical Care Trials G (2012) Daily sedation interruption in mechanically ventilated critically ill patients cared for with a sedation protocol: a randomized controlled trial. JAMA 308:1985–1992PubMedCrossRefGoogle Scholar
  31. 31.
    Barr J, Fraser GL, Puntillo K, Ely EW, Gelinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R (2013) Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 41:263–306PubMedCrossRefGoogle Scholar
  32. 32.
    Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW, Bowton DL, Haponik EF (1996) Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 335:1864–1869PubMedCrossRefGoogle Scholar
  33. 33.
    Girard TD, Kress JP, Fuchs BD, Thomason JW, Schweickert WD, Pun BT, Taichman DB, Dunn JG, Pohlman AS, Kinniry PA, Jackson JC, Canonico AE, Light RW, Shintani AK, Thompson JL, Gordon SM, Hall JB, Dittus RS, Bernard GR, Ely EW (2008) Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet 371:126–134PubMedCrossRefGoogle Scholar
  34. 34.
    Strom T, Martinussen T, Toft P (2010) A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial. Lancet 375:475–480PubMedCrossRefGoogle Scholar
  35. 35.
    Citerio G, Cormio M (2003) Sedation in neurointensive care: advances in understanding and practice. Curr Opin Crit Care 9:120–126PubMedCrossRefGoogle Scholar
  36. 36.
    Skoglund K, Enblad P, Marklund N (2009) Effects of the neurological wake-up test on intracranial pressure and cerebral perfusion pressure in brain-injured patients. Neurocrit Care 11:135–142PubMedCrossRefGoogle Scholar
  37. 37.
    Helbok R, Kurtz P, Schmidt MJ, Fernandez L, Connolly SE, Lee K, Schmutzhard E, Mayer SA, Claassen J, Badjatia N (2012) Effects of the neurological wake-up test on clinical examination, intracranial pressure, brain metabolism and brain tissue oxygenation in severely brain-injured patients. Crit Care 16:R226PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Stevens RD, Bhardwaj A (2006) Approach to the comatose patient. Crit Care Med 34:31–41PubMedCrossRefGoogle Scholar
  39. 39.
    Fischer M, Ruegg S, Czaplinski A, Strohmeier M, Lehmann A, Tschan F, Hunziker PR, Marsch SC (2010) Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study. Crit Care 14:R64PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Iyer VN, Mandrekar JN, Danielson RD, Zubkov AY, Elmer JL, Wijdicks EF (2009) Validity of the FOUR score coma scale in the medical intensive care unit. Mayo Clin Proc 84:694–701PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Stead LG, Wijdicks EF, Bhagra A, Kashyap R, Bellolio MF, Nash DL, Enduri S, Schears R, William B (2009) Validation of a new coma scale, the FOUR score, in the emergency department. Neurocrit Care 10:50–54PubMedCrossRefGoogle Scholar
  42. 42.
    Weiss N, Mutlu G, Essardy F, Nacabal C, Sauves C, Bally C, Houbert M, Lecorre C, Germack V, Demeret S, Pierrot-Deseilligny C, Bolgert F (2009) The French version of the FOUR score: a new coma score. Rev Neurol (Paris) 165:796–802CrossRefGoogle Scholar
  43. 43.
    American Psychiatric Association (2000) Task Force on DSM-IV. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. American Psychiatry Association, Washington, DCGoogle Scholar
  44. 44.
    Lin SM, Liu CY, Wang CH, Lin HC, Huang CD, Huang PY, Fang YF, Shieh MH, Kuo HP (2004) The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med 32:2254–2259PubMedCrossRefGoogle Scholar
  45. 45.
    Pompei P, Foreman M, Rudberg MA, Inouye SK, Braund V, Cassel CK (1994) Delirium in hospitalized older persons: outcomes and predictors. J Am Geriatr Soc 42:809–815PubMedGoogle Scholar
  46. 46.
    Lemyze M, Mallat J, Nigeon O, Barrailler S, Pepy F, Gasan G, Vangrunderbeeck N, Grosset P, Tronchon L, Thevenin D (2013) Rescue therapy by switching to total face mask after failure of face mask-delivered noninvasive ventilation in do-not-intubate patients in acute respiratory failure. Crit Care Med 41:481–488PubMedCrossRefGoogle Scholar
  47. 47.
    Milbrandt EB, Deppen S, Harrison PL, Shintani AK, Speroff T, Stiles RA, Truman B, Bernard GR, Dittus RS, Ely EW (2004) Costs associated with delirium in mechanically ventilated patients. Crit Care Med 32:955–962PubMedCrossRefGoogle Scholar
  48. 48.
    Pisani MA, Kong SY, Kasl SV, Murphy TE, Araujo KL, Van Ness PH (2009) Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med 180:1092–1097PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    O’Keeffe S, Lavan J (1997) The prognostic significance of delirium in older hospital patients. J Am Geriatr Soc 45:174–178PubMedGoogle Scholar
  50. 50.
    Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA (2010) Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA 304:443–451PubMedCrossRefGoogle Scholar
  51. 51.
    Balas MC, Happ MB, Yang W, Chelluri L, Richmond T (2009) Outcomes associated with delirium in older patients in surgical ICUs. Chest 135:18–25PubMedCentralPubMedCrossRefGoogle Scholar
  52. 52.
    Salluh JI, Soares M, Teles JM, Ceraso D, Raimondi N, Nava VS, Blasquez P, Ugarte S, Ibanez-Guzman C, Centeno JV, Laca M, Grecco G, Jimenez E, Arias-Rivera S, Duenas C, Rocha MG (2010) Delirium epidemiology in critical care (DECCA): an international study. Crit Care 14:R210PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Spronk PE, Riekerk B, Hofhuis J, Rommes JH (2009) Occurrence of delirium is severely underestimated in the ICU during daily care. Intensive Care Med 35:1276–1280PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Devlin JW, Fong JJ, Schumaker G, O’Connor H, Ruthazer R, Garpestad E (2007) Use of a validated delirium assessment tool improves the ability of physicians to identify delirium in medical intensive care unit patients. Crit Care Med 35:2721–2724 (quiz 2725)PubMedCrossRefGoogle Scholar
  55. 55.
    George C, Nair JS, Ebenezer JA, Gangadharan A, Christudas A, Gnanaseelan LK, Jacob KS (2011) Validation of the Intensive Care Delirium Screening Checklist in nonintubated intensive care unit patients in a resource-poor medical intensive care setting in South India. J Crit Care 26:138–143PubMedCrossRefGoogle Scholar
  56. 56.
    van Eijk MM, van den Boogaard M, van Marum RJ, Benner P, Eikelenboom P, Honing ML, van der Hoven B, Horn J, Izaks GJ, Kalf A, Karakus A, Klijn IA, Kuiper MA, de Leeuw FE, de Man T, van der Mast RC, Osse RJ, de Rooij SE, Spronk PE, van der Voort PH, van Gool WA, Slooter AJ (2011) Routine use of the confusion assessment method for the intensive care unit: a multicenter study. Am J Respir Crit Care Med 184:340–344PubMedCrossRefGoogle Scholar
  57. 57.
    Radtke FM, Heymann A, Franck M, Maechler F, Drews T, Luetz A, Nachtigall I, Wernecke KD, Spies CD (2012) How to implement monitoring tools for sedation, pain and delirium in the intensive care unit: an experimental cohort study. Intensive Care Med 38:1974–1981PubMedCrossRefGoogle Scholar
  58. 58.
    Fagundes JA, Tomasi CD, Giombelli VR, Alves SC, de Macedo RC, Topanotti MF, de Lourdes Ugioni Bristot M, do Brasil PE, Soares M, Salluh J, Dal-Pizzol F, Ritter C (2012) CAM-ICU and ICDSC agreement in medical and surgical ICU patients is influenced by disease severity. PLoS ONE 7: e51010Google Scholar
  59. 59.
    Plaschke K, von Haken R, Scholz M, Engelhardt R, Brobeil A, Martin E, Weigand MA (2008) Comparison of the confusion assessment method for the intensive care unit (CAM-ICU) with the Intensive Care Delirium Screening Checklist (ICDSC) for delirium in critical care patients gives high agreement rate(s). Intensive Care Med 34:431–436PubMedCrossRefGoogle Scholar
  60. 60.
    Wijman CA, Mlynash M, Caulfield AF, Hsia AW, Eyngorn I, Bammer R, Fischbein N, Albers GW, Moseley M (2009) Prognostic value of brain diffusion-weighted imaging after cardiac arrest. Ann Neurol 65:394–402PubMedCentralPubMedCrossRefGoogle Scholar
  61. 61.
    Sharshar T, Carlier R, Bernard F, Guidoux C, Brouland JP, Nardi O, de la Grandmaison GL, Aboab J, Gray F, Menon D, Annane D (2007) Brain lesions in septic shock: a magnetic resonance imaging study. Intensive Care Med 33:798–806PubMedCrossRefGoogle Scholar
  62. 62.
    Latronico N, Bolton CF (2011) Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol 10:931–941PubMedCrossRefGoogle Scholar
  63. 63.
    Daube JR (1991) AAEM minimonograph #11: needle examination in clinical electromyography. Muscle Nerve 14:685–700PubMedCrossRefGoogle Scholar
  64. 64.
    Latronico N, Shehu I, Guarneri B (2009) Use of electrophysiologic testing. Crit Care Med 37:S316–S320PubMedCrossRefGoogle Scholar
  65. 65.
    Winer JB (2008) Guillain–Barre syndrome. BMJ 337:a671PubMedCrossRefGoogle Scholar
  66. 66.
    Staff NP, Engelstad J, Klein CJ, Amrami KK, Spinner RJ, Dyck PJ, Warner MA, Warner ME (2010) Post-surgical inflammatory neuropathy. Brain 133:2866–2880PubMedCrossRefGoogle Scholar
  67. 67.
    Sheridana EA, Cepeda J, De Palma R, Brett MM, Nagendran K (2004) A drug user with a sore throat. Lancet 364:1286PubMedCrossRefGoogle Scholar
  68. 68.
    Felz MW, Smith CD, Swift TR (2000) A six-year-old girl with tick paralysis. N Engl J Med 342:90–94PubMedCrossRefGoogle Scholar
  69. 69.
    Stevens RD, Sutter R (2013) Prognosis in severe brain injury. Crit Care Med 41:1104–1123PubMedCrossRefGoogle Scholar
  70. 70.
    Perel P, Arango M, Clayton T, Edwards P, Komolafe E, Poccock S, Roberts I, Shakur H, Steyerberg E, Yutthakasemsunt S (2008) Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ 336:425–429PubMedCrossRefGoogle Scholar
  71. 71.
    Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, Murray GD, Marmarou A, Roberts I, Habbema JD, Maas AI (2008) Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med 5:e165 (discussion e165)PubMedCentralPubMedCrossRefGoogle Scholar
  72. 72.
    Wijdicks EF, Hijdra A, Young GB, Bassetti CL, Wiebe S, Quality Standards Subcommittee of the American Academy of N (2006) Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 67:203–210PubMedCrossRefGoogle Scholar
  73. 73.
    Sandroni C, Cavallaro F, Callaway CW, Sanna T, D’Arrigo S, Kuiper M, Della Marca G, Nolan JP (2013) Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 1: patients not treated with therapeutic hypothermia. Resuscitation 84:1310–1323PubMedCrossRefGoogle Scholar
  74. 74.
    Rossetti AO, Oddo M, Logroscino G, Kaplan PW (2010) Prognostication after cardiac arrest and hypothermia: a prospective study. Ann Neurol 67:301–307PubMedGoogle Scholar
  75. 75.
    Sandroni C, Cavallaro F, Callaway CW, Sanna T, D’Arrigo S, Kuiper M, Della Marca G, Nolan JP (2013) Predictors of poor neurological outcome in adult comatose survivors of cardiac arrest: a systematic review and meta-analysis. Part 2: patients treated with therapeutic hypothermia. Resuscitation 84:1324–1338PubMedCrossRefGoogle Scholar
  76. 76.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRefGoogle Scholar
  77. 77.
    Hamel MB, Phillips R, Teno J, Davis RB, Goldman L, Lynn J, Desbiens N, Connors AF Jr, Tsevat J (2002) Cost effectiveness of aggressive care for patients with nontraumatic coma. Crit Care Med 30:1191–1196PubMedCrossRefGoogle Scholar
  78. 78.
    Stevens RD et al (2009) A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med 37(Suppl 10):S299–S308Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Tarek Sharshar
    • 8
    • 9
  • Giuseppe Citerio
    • 3
  • Peter J. D. Andrews
    • 1
  • Arturo Chieregato
    • 2
  • Nicola Latronico
    • 4
  • David K. Menon
    • 5
  • Louis Puybasset
    • 6
  • Claudio Sandroni
    • 7
  • Robert D. Stevens
    • 10
  1. 1.Centre for Clinical Brain Sciences and NHS Lothian, Western General HospitalUniversity of EdinburghEdinburghUK
  2. 2.Anaesthesia and Intensive Care Medicine, CTOAzienda Ospedaliera Universitaria CareggiFlorenceItaly
  3. 3.Neuroanaesthesia and Neurointensive Care Unit, Anestesia e RianimazioneSan Gerardo Hospital, MonzaMilanItaly
  4. 4.University Division of Anesthesia and Intensive Care MedicineUniversity of BresciaBresciaItaly
  5. 5.Department of AnaesthesiaUniversity of CambridgeCambridgeUK
  6. 6.Neuro Intensive Care Unit, Department of Anesthesia and Intensive Care Pitié-Salpêtrière HospitalUniversity Pierre et Marie Curie, Paris VI, Assistance-Publique Hôpitaux de ParisParisFrance
  7. 7.Department of Anaesthesiology and Intensive CareCatholic University School of MedicineRomeItaly
  8. 8.Service de Réanimation Polyvalente Raymond Poincaré Teaching HospitalUniversity of Versailles, Assistance-Publique Hôpitaux de ParisGarchesFrance
  9. 9.Laboratoire d’Histopathologie et de Modèles Animaux Instiut PasteurParisFrance
  10. 10.Neurosciences Critical Care DivisionJohns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations