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Magnetic Resonance Imaging in Neurocritically Ill Patients

Who Fails and How?

Kim, Joong-Goo, MD; Ko, Myung-Ah, MD; Lee, Han-Bin, MD; Jeon, Sang-Beom, MD, PhD

doi: 10.1097/PTS.0000000000000483
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Objectives Performing magnetic resonance imaging (MRI) in neurocritically ill patients is challenging because it often requires sedation and withholding care in the neurological intensive care unit. This study investigated the incidence of and reasons for failed or complicated MRI (MRI-FC) in such patients.

Methods A consecutive series of 218 neurocritically ill patients who underwent brain MRI were retrospectively evaluated. Failed or complicated MRI included failure to obtain all ordered sequences, unscheduled sedative administration, decrease in oxygen saturation to less than 90%, hypotension (≥40-mm Hg decrease and/or use of inotropic agents), and cardiac or respiratory arrest.

Results Failed or complicated MRI occurred in 66 patients (30.3%) and included failure to obtain MRI sequences (n = 13), unscheduled use of sedatives (n = 62), oxygen desaturation (n = 9), and hypotension (n = 6). Cardiac or respiratory arrest did not occur. Use of sedative agents while in intensive care (P < 0.01), high Acute Physiology and Chronic Health Evaluation II score (P = 0.031), and low Glasgow Coma Scale score on admission (P = 0.047) were associated with MRI-FC. Scan times were longer (P = 0.004) and Glasgow Coma Scale (P < 0.001) and Richmond Agitation Sedation Scale (P = 0.003) scores were lower (P = 0.004) after imaging in patients with MRI-FC. Previous use of sedative agents was independently associated with MRI-FC (adjusted odds ratio = 3.57, 95% confidence interval = 1.78 to 7.24, P < 0.001).

Conclusions Failed or complicated MRI was common and was associated with the use of sedative agents, severity of illness, and lower level of consciousness. Studies to ensure effective and safe performance of MRI in neurocritically ill patients are needed.

From the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Correspondence: Sang-Beom Jeon, MD, PhD, Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea (e-mail: sbjeonmd@gmail.com).

The authors disclose no conflict of interest.

This work was conducted in and was solely supported by the Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Ethical approval was granted according to national requirements, and the need for written informed consent was waived. (Institutional Review Board at Asan Medical Center: S2016-1855-0002)

J.G.K., M.A.K., H.B.L., and S.B.J. recruited patients. J.G.K. and S.B.J. designed the study, interpreted the data, and wrote the article. All authors read, revised, and approved the article.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.journalpatientsafety.com).

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