Estímulos sonoros e desfechos clínicos em pacientes com distúrbios da consciência: análise em unidade de terapia intensiva

Abstract

Disorders of consciousness (DoC) pose a major challenge in the intensive care unit (ICU), particularly regarding diagnosis, prognosis, and therapeutic decision-making. In this context, electroencephalography (EEG) combined with auditory stimulation has been investigated as a promising strategy to assess cortical responsiveness and assist in monitoring the clinical evolution of critically ill patients. This study aimed to describe the demographic and clinical profile of patients with DoC; characterize their clinical course during hospitalization; ana-lyze hospital outcomes; and evaluate behavioral responses to auditory stimulation recorded simultaneously with EEG. This is a cross-sectional, quantitative, and analytical study con-ducted with DoC patients admitted to the Adult ICU of the Hospital de Clínicas de Uber-lândia, for whom an EEG had been requested by the attending team. EEG recordings were performed at bedside over a 20-minute session comprising six auditory stimuli interspersed with verbal stimulation. A wide range of demographic and clinical variables from admis-sion, intervention, and hospital discharge were collected directly from electronic medical records. Statistical analyses were performed using the Statistical Package for the Social Sci-ences (SPSS). A total of 22 patients participated in the study, predominantly male (68.2%), with a mean age of 55.63 years. The clinical profile was heterogeneous, with substantial var-iation in DoC etiologies, severity, and general condition at admission. Clinical evolution during hospitalization varied significantly; longer ICU stay and advanced age were associat-ed with poorer levels of consciousness at discharge. Infectious complications, the need for invasive devices, and cardiorespiratory arrest were observed in part of the sample, contrib-uting to longer hospital stays and worse outcomes. Patients with traumatic brain injury demonstrated higher consciousness scores at discharge compared to other etiologies. Fol-lowing auditory stimulation, some patients exhibited increases in Glasgow Coma Scale scores, whereas sedated individuals showed little change, supporting the notion that the level of sedation influences responsiveness. In conclusion, the integrated analysis of clinical and neurophysiological data contributes to improving clinical management, providing support for the development of more precise and individualized monitoring strategies aimed at en-hancing care for patients with DoC.