defined by a Richmond Agitation-Sedation Scale (RASS) (RASS) < -3
Deep sedation may hamper the detection of neurological deterioration in brain injury.
Impaired brainstem reflexes within the first 24 h of deep sedation are associated with increased mortality in non-brain-injured patients.
Early (day 1) cough reflex abolition is an independent predictor of mortality in deeply sedated brain-injured patients. Abolished cough reflex likely reflects a brainstem dysfunction that might result from the combination of primary and secondary neuro-inflammatory cerebral insults revealed and/or worsened by sedation 1).