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Quantitative versus...
Quantitative versus standard pupillary light reflex for early prognostication in comatose cardiac arrest patients : an international prospective multicenter double-blinded study
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- Oddo, Mauro (författare)
- Lausanne University Hospital
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- Sandroni, Claudio (författare)
- Catholic University School of Medicine
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- Citerio, Giuseppe (författare)
- European Institute of Oncology,San Gerardo Hospital
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- Miroz, John Paul (författare)
- Lausanne University Hospital
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- Horn, Janneke (författare)
- Academic Medical Center of University of Amsterdam (AMC)
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- Rundgren, Malin (författare)
- Lund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Center for cardiac arrest,Lund University Research Groups,Skåne University Hospital
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- Cariou, Alain (författare)
- Paris Descartes University,Cochin Hospital
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- Payen, Jean François (författare)
- University Grenoble Alpes
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- Storm, Christian (författare)
- Charité - University Medicine Berlin
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- Stammet, Pascal (författare)
- National Fire and Rescue Corps
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- Taccone, Fabio Silvio (författare)
- Université Libre de Bruxelles (ULB)
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(creator_code:org_t)
- 2018-11-26
- 2018
- Engelska 10 s.
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 44:12, s. 2102-2111
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http://dx.doi.org/10... (free)
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https://link.springe...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Purpose: To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA). Methods: We performed a prospective international multicenter study (10 centers) in adult comatose CA patients. Quantitative NPi and standard manual pupillary light reflex (sPLR)—blinded to clinicians and outcome assessors—were recorded in parallel from day 1 to 3 after CA. Primary study endpoint was to compare the value of NPi versus sPLR to predict 3-month Cerebral Performance Category (CPC), dichotomized as favorable (CPC 1–2: full recovery or moderate disability) versus unfavorable outcome (CPC 3–5: severe disability, vegetative state, or death). Results: At any time between day 1 and 3, an NPi ≤ 2 (n = 456 patients) had a 51% (95% CI 49–53) negative predictive value and a 100% positive predictive value [PPV; 0% (0–2) false-positive rate], with a 100% (98–100) specificity and 32% (27–38) sensitivity for the prediction of unfavorable outcome. Compared with NPi, sPLR had significantly lower PPV and significantly lower specificity (p < 0.001 at day 1 and 2; p = 0.06 at day 3). The combination of NPi ≤ 2 with bilaterally absent somatosensory evoked potentials (SSEP; n = 188 patients) provided higher sensitivity [58% (49–67) vs. 48% (39–57) for SSEP alone], with comparable specificity [100% (94–100)]. Conclusions: Quantitative NPi had excellent ability to predict an unfavorable outcome from day 1 after CA, with no false positives, and significantly higher specificity than standard manual pupillary examination. The addition of NPi to SSEP increased sensitivity of outcome prediction, while maintaining 100% specificity.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- Cardiac arrest
- Neurological pupil index
- Outcome
- Prognostication
- Pupillary reactivity
- Pupillometry
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- ref (ämneskategori)
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Oddo, Mauro
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Sandroni, Claudi ...
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Citerio, Giusepp ...
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Miroz, John Paul
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Horn, Janneke
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Rundgren, Malin
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Cariou, Alain
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Payen, Jean Fran ...
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Storm, Christian
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Stammet, Pascal
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Taccone, Fabio S ...
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Kardiologi
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Intensive Care M ...
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Lunds universitet