Academic Journal
Auditory Stimuli Most Effective in Eliciting Reactivity in Critically Ill Patients with an Impaired Consciousness.
| Τίτλος: | Auditory Stimuli Most Effective in Eliciting Reactivity in Critically Ill Patients with an Impaired Consciousness. |
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| Συγγραφείς: | Haksteen WE; Department of Intensive Care, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. w.e.haksteen@amsterdamumc.nl., Zandbergen LNK; Department of Intensive Care, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Eleveld N; Department of Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Horn J; Department of Intensive Care, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., van Rootselaar AF; Department of Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. |
| Πηγή: | Neurocritical care [Neurocrit Care] 2026 Aug; Vol. 45 (1), pp. 171-180. Date of Electronic Publication: 2026 Feb 11. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Humana Press Country of Publication: United States NLM ID: 101156086 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1556-0961 (Electronic) Linking ISSN: 15416933 NLM ISO Abbreviation: Neurocrit Care Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Totowa, NJ : Humana Press, c2004- |
| Ιατρικοί όροι (MeSH): | Electroencephalography*/methods , Electroencephalography*/standards , Acoustic Stimulation*/methods , Acoustic Stimulation*/standards , Consciousness Disorders*/physiopathology , Consciousness Disorders*/diagnosis , Consciousness Disorders*/etiology , Brain Injuries, Traumatic*/physiopathology , Brain Injuries, Traumatic*/complications , Critical Illness* , Outcome Assessment, Health Care*, Humans ; Female ; Male ; Middle Aged ; Aged ; Intensive Care Units ; Adult ; Reproducibility of Results |
| Περίληψη: | Background: Electroencephalograpy (EEG) reactivity may aid functional outcome prediction in the intensive care unit (ICU). Different types of stimuli could vary in their ability to evoke reactivity. This study explored which type of stimulus is best to elicit EEG reactivity in ICU patients with an impaired consciousness. We also investigated associations between reactivity and hospital survival and functional outcome. Lastly, we compared standardized testing with random stimuli application. Methods: Adult ICU patients with an impaired consciousness and an EEG with reactivity testing were screened for eligibility. Stimuli were auditory (clapping and calling patient's name), visual, tactile, and noxious. Three raters, blinded to clinical outcomes, scored each EEG recording and stimulus for reactivity. Interrater reliability was assessed using Fleiss' kappa. Associations between reactivity and outcomes were analyzed with logistic regression. Results: In total, 72 patients were included, most commonly with traumatic brain injury which was present in 19 patients (26.4%) and a median GCS score of 6 (interquartile range, IQR 3-11). EEG reactivity was present in 30.6% of patients. Auditory stimuli were most effective, accounting for 57% of all reactive stimuli. Interrater reliability was highest for clapping (κ = 0.633, 77% raw agreement) and calling the patient's name (κ = 0.584, 74% raw agreement). Reactivity was not associated with hospital survival or 6-month functional outcome. Standardized testing was applied in 23.6% of patients and improved raters' certainty in detecting reactivity compared with the application of random stimuli (88.2% vs. 41.8%, p = 0.002). Conclusions: Auditory stimuli (clapping and calling the patient's name) proved most effective in eliciting EEG reactivity. Reactivity was not associated with outcomes. Standardized testing increased raters' certainty in detecting reactivity. (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Conflict of interest: The authors declare they have no conflicts of interest. Ethical Approval: The local Medical Ethical Committee approved the IMPROVE-DOC study on December 5, 2022 (reference number: 2022–0661–NL82013.018.22) and the REACT-DOC study on May 21, 2025 (reference number: 2025.0026). Deferred consent was obtained from legal representatives of all prospectively included patients within 72 h after enrollment and, if possible, from the patients themselves after regaining consciousness. For retrospectively included patients, a no-objection procedure was used: patients were informed of the intention to include them in the study and were given the opportunity to decline participation within four weeks of notification. For deceased patients, the need for a no-objection procedure was waived. |
| References: | Clin Neurophysiol. 2021 Jul;132(7):1687-1693. (PMID: 34049028) Eur J Neurol. 2017 Feb;24(2):245-254. (PMID: 27981707) Crit Care. 2018 Aug 2;22(1):184. (PMID: 30071861) Intensive Care Med. 2022 Oct;48(10):1443-1462. (PMID: 35997792) J Crit Care. 2024 Dec;84:154861. (PMID: 39018590) Clin Neurophysiol. 2019 Aug;130(8):1263-1270. (PMID: 31163372) Neurocrit Care. 2014 Dec;21 Suppl 2:S297-361. (PMID: 25608916) Resuscitation. 2021 Apr;161:220-269. (PMID: 33773827) J Clin Neurophysiol. 2021 Jan 1;38(1):1-29. (PMID: 33475321) Clin Interv Aging. 2023 Feb 18;18:249-261. (PMID: 36843633) Lancet Neurol. 2022 Aug;21(8):704-713. (PMID: 35841909) Ann Intensive Care. 2015 Dec;5(1):52. (PMID: 26690797) PLoS One. 2015 Oct 08;10(10):e0139969. (PMID: 26447697) J Neurotrauma. 2021 Sep 1;38(17):2435-2446. (PMID: 33740873) Clin Neurophysiol. 2016 Nov;127(11):3412-3417. (PMID: 27693940) Clin Neurophysiol. 2015 May;126(5):959-66. (PMID: 25238957) Neurocrit Care. 2024 Apr;40(2):718-733. (PMID: 37697124) J Clin Neurophysiol. 2024 Nov 1;41(7):577-588. (PMID: 38857365) Nat Med. 2024 Aug;30(8):2349-2355. (PMID: 38816609) Chin Med J (Engl). 2017 Aug 5;130(15):1851-1855. (PMID: 28748859) Sci Rep. 2024 Jul 29;14(1):17446. (PMID: 39075138) Neurocrit Care. 2023 Jun;38(3):533-563. (PMID: 36949360) Ann Neurol. 2019 Jul;86(1):17-27. (PMID: 31124174) Resuscitation. 2015 Dec;97:34-7. (PMID: 26409220) Br J Anaesth. 2023 Feb;130(2):e225-e232. (PMID: 36243578) Clin EEG Neurosci. 2017 Nov;48(6):428-437. (PMID: 28844160) JAMA Neurol. 2024 Mar 4;:. (PMID: 38436946) Intensive Care Med. 2015 Apr;41(4):686-94. (PMID: 25763756) Neurology. 2020 Aug 11;95(6):e653-e661. (PMID: 32651293) Intensive Care Med. 2013 Aug;39(8):1337-51. (PMID: 23653183) Biometrics. 1977 Mar;33(1):159-74. (PMID: 843571) BJA Educ. 2019 Mar;19(3):74-82. (PMID: 33456874) Resuscitation. 2019 Sep;142:168-174. (PMID: 31211949) |
| Contributed Indexing: | Keywords: Brain injuries; Coma; Critical care; Electroencephalography; Reactivity |
| Entry Date(s): | Date Created: 20260211 Date Completed: 20260715 Latest Revision: 20261016 |
| Update Code: | 20261017 |
| PubMed Central ID: | PMC13369764 |
| DOI: | 10.1007/s12028-026-02457-8 |
| PMID: | 41673383 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1556-0961 |
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| DOI: | 10.1007/s12028-026-02457-8 |