{"id":24369,"date":"2023-08-11T04:34:00","date_gmt":"2023-08-10T20:34:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=24369"},"modified":"2023-08-11T05:40:11","modified_gmt":"2023-08-10T21:40:11","slug":"intensive-care-med%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%8f%b3%e6%ad%a3%e4%b8%ad%e7%a5%9e%e7%bb%8f%e7%94%b5%e5%88%ba%e6%bf%80%e4%bf%83%e9%86%92%e6%80%a5%e6%80%a7%e5%88%9b%e4%bc%a4%e6%80%a7","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=24369","title":{"rendered":"[Intensive Care Med\u53d1\u8868\u8bba\u6587]\uff1a\u53f3\u6b63\u4e2d\u795e\u7ecf\u7535\u523a\u6fc0\u4fc3\u9192\u6025\u6027\u521b\u4f24\u6027\u660f\u8ff7\u60a3\u8005"},"content":{"rendered":"\n<ul>\n<li>Original<\/li>\n\n\n\n<li><a href=\"https:\/\/www.springernature.com\/gp\/open-research\/about\/the-fundamentals-of-open-access-and-open-research\">Open Access<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/link.springer.com\/article\/10.1007\/s00134-023-07072-1#article-info\">Published:&nbsp;<time datetime=\"2023-05-13\">13 May 2023<\/time><\/a><\/li>\n<\/ul>\n\n\n\n<h1 class=\"wp-block-heading\">Acute traumatic coma awakening by right median nerve electrical stimulation: a randomised controlled trial<\/h1>\n\n\n\n<p>Xiang Wu,\u00a0Li Xie,\u00a0Jin Lei,\u00a0et al<\/p>\n\n\n\n<p><a href=\"https:\/\/link.springer.com\/journal\/134\"><em>Intensive Care Medicine<\/em><\/a>&nbsp;<strong>volume&nbsp;49<\/strong>,&nbsp;pages&nbsp;633\u2013644 (2023)<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"Abs1\">Abstract<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Purpose<\/h3>\n\n\n\n<p>Severe traumatic brain injury (TBI) leads to acute coma and may result in prolonged disorder of consciousness (pDOC). We aimed to determine whether right median nerve electrical stimulation is a safe and effective treatment for accelerating emergence from coma after TBI.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Methods<\/h3>\n\n\n\n<p>This randomised controlled trial was performed in 22 centres in China. Participants with acute coma at 7\u201314&nbsp;days after TBI were randomly assigned (1:1) to either routine therapy and right median nerve electrical stimulation (RMNS group) or routine treatment (control group). The RMNS group received 20&nbsp;mA, 300&nbsp;\u03bcs, 40&nbsp;Hz stimulation pulses, lasting 20&nbsp;s per minutes, 8&nbsp;h per day, for 2&nbsp;weeks. The primary outcome was the proportion of patients who regained consciousness 6&nbsp;months post-injury. The secondary endpoints were Glasgow Coma Scale (GCS), Full Outline of Unresponsiveness scale (FOUR), Coma Recovery Scale-Revised (CRS-R), Disability Rating Scale (DRS) and Glasgow Outcome Scale Extended (GOSE) scores reported as medians on day 28, 3&nbsp;months and 6&nbsp;months after injury, and GCS and FOUR scores on day 1 and day 7 during stimulation. Primary analyses were based on the intention-to-treat set.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Results<\/h3>\n\n\n\n<p>Between March 26, 2016, and October 18, 2020, 329 participants were recruited, of whom 167 were randomised to the RMNS group and 162 to the control group. At 6\u00a0months post-injury, a higher proportion of patients in the RMNS group regained consciousness compared with the control group (72.5%,\u00a0<em>n<\/em>\u2009=\u2009121, 95% confidence interval (CI) 65.2\u201378.7% vs. 56.8%,\u00a0<em>n<\/em>\u2009=\u200992, 95% CI 49.1\u201364.2%,\u00a0<em>p<\/em>\u2009=\u20090.004). GOSE at 3\u00a0months and 6\u00a0months (5 [interquartile range (IQR) 3\u20137] vs. 4 [IQR 2\u20136],\u00a0<em>p<\/em>\u2009=\u20090.002; 6 [IQR 3\u20137] vs. 4 [IQR 2\u20137],\u00a0<em>p<\/em>\u2009=\u20090.0005) and FOUR at 28\u00a0days (15 [IQR 13\u201316] vs. 13 [interquartile range (IQR) 11\u201316],\u00a0<em>p<\/em>\u2009=\u20090.002) were significantly increased in the RMNS group compared with the control group. Trajectory analysis showed that significantly more patients in the RMNS group had faster GCS, CRS-R and DRS improvement (<em>p<\/em>\u2009=\u20090.01, 0.004 and 0.04, respectively). Adverse events were similar in both groups. No serious adverse events were associated with the stimulation device.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/media.springernature.com\/full\/springer-static\/image\/art%3A10.1007%2Fs00134-023-07072-1\/MediaObjects\/134_2023_7072_Fig1_HTML.png?as=webp\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/media.springernature.com\/full\/springer-static\/image\/art%3A10.1007%2Fs00134-023-07072-1\/MediaObjects\/134_2023_7072_Fig2_HTML.png?as=webp\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/media.springernature.com\/full\/springer-static\/image\/art%3A10.1007%2Fs00134-023-07072-1\/MediaObjects\/134_2023_7072_Fig3_HTML.png?as=webp\" alt=\"\"\/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/media.springernature.com\/full\/springer-static\/image\/art%3A10.1007%2Fs00134-023-07072-1\/MediaObjects\/134_2023_7072_Fig4_HTML.png?as=webp\" alt=\"\"\/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Conclusion<\/h3>\n\n\n\n<p>Right median nerve electrical stimulation is a possible effective treatment for patients with acute traumatic coma, that will require validation in a confirmatory trial.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Acute traumatic coma awakening by right median nerve el [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24369"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=24369"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24369\/revisions"}],"predecessor-version":[{"id":24370,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/24369\/revisions\/24370"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=24369"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=24369"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=24369"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}