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Status Epilepticus
| Content Provider | Scilit |
|---|---|
| Author | Marchi, Nicola A. Novy, Jan Faouzi, Mohamed Stähli, Christine Burnand, Bernard Rossetti, Andrea O. |
| Copyright Year | 2015 |
| Description | Journal: Critical Care Medicine Therapeutic coma is advocated in guidelines for management of refractory status epilepticus; this is, however, based on weak evidence. We here address the specific impact of therapeutic coma on status epilepticus outcome.Retrospective assessment of a prospectively collected cohort.Academic hospital.Consecutive adults with incident status epilepticus lasting greater than or equal to 30 minutes, admitted between 2006 and 2013.We recorded prospectively demographics, clinical status epilepticus features, treatment, and outcome at discharge and retrospectively medical comorbidities, hospital stay, and infectious complications. Associations between potential predictors and clinical outcome were analyzed using multinomial logistic regressions. Of 467 patients with incident status epilepticus, 238 returned to baseline (51.1%), 162 had new disability (34.6%), and 67 died (14.3%); 50 subjects (10.7%) were managed with therapeutic coma. Therapeutic coma was associated with poorer outcome in the whole cohort (relative risk ratio for new disability, 6.86; 95% CI, 2.84-16.56; for mortality, 9.10; 95% CI, 3.17-26.16); the effect was more important in patients with complex partial compared with generalized convulsive or nonconvulsive status epilepticus in coma. Prevalence of infections was higher (odds ratio, 3.81; 95% CI, 1.66-8.75), and median hospital stay in patients discharged alive was longer (16 d [range, 2-240 d] vs 9 d [range, 1-57 d]; p < 0.001) in subjects managed with therapeutic coma.This study provides class III evidence that therapeutic coma is associated with poorer outcome after status epilepticus; furthermore, it portends higher infection rates and longer hospitalizations. These data suggest caution in the straightforward use of this approach, especially in patients with complex partial status epilepticus. |
| Related Links | https://serval.unil.ch/resource/serval:BIB_86CB92A9BF75.P002/REF.pdf |
| Ending Page | 1009 |
| Page Count | 7 |
| Starting Page | 1003 |
| ISSN | 00903493 |
| e-ISSN | 15300293 |
| DOI | 10.1097/ccm.0000000000000881 |
| Journal | Critical Care Medicine |
| Issue Number | 5 |
| Volume Number | 43 |
| Language | English |
| Publisher | Ovid Technologies (Wolters Kluwer Health) |
| Publisher Date | 2015-05-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: Critical Care Medicine Critical Care Medicine Therapeutic Coma Poorer Outcome Complex Partial Hospital Stay Managed with Therapeutic |
| Content Type | Text |
| Resource Type | Article |
| Subject | Critical Care and Intensive Care Medicine |
