Ricerc@Sapienza

Introduction: Severe brain injuries are always associated with alterations of vital functions and neurological deficits. Length of time period between the damaging event and the start of the rehabilitation treatment is prognostically important. It is useful, therefore, to identify an evaluation method that leaves aside the subjectivity to predict the timing of a possible cognitive recovery. From this perspective, potential related events (ERPs) seem to provide good results. Aim of our work was to test the feasibility of P300 in intensive care unit and its possible correlation with the rehabilitation outcome. Clinical series: We enrolled 5 subjects admitted to the post-operative Intensive Care Unit (ICU) of Sant’Andrea Hospital in Rome, following a severe haemorrhagic insult. All subjects had significant deficits and airway incompetence. After 48 hours from admission in ICU analysis of P300 was performed. The analysis of P300 was conducted by a stimulus called odd-ball. Acoustic stimulation was active, exogenous and synchronous. The recordings were made using cup electrodes, referred to passive electrodes located at the ear lobes and grounded. Results: One patient died after two weeks. Two patients, showed P300 values ≤ 400ms. They reached a Glasgow Outcome Scale (GOS) value of 3. Other two patients showed P300 values > 400ms. Their GOS reached a value of 2 and they did not regain environmental contact. Conclusion: Survival increase in subjects suffering from severe brain damage made rehabilitation more important to recover the disabilities resulting from the event. The potential for recovery is based fundamentally on an early intervention. The possibility of identifying one indicator on the real chances of benefiting from rehabilitation treatment falls within the clinical priorities. Potential related events (ERPs) are able to convey information related to the reception and processing of sensory stimuli. Among ERPs, P300 seems to be the best permorfer. In our clinical series the value of P300 ranged from 382ms to 553ms. We were able to identify the value of 400 as a discriminant for a good functional recovery.