Abstract：
BACKGROUND: Management of status epilepticus (SE) is focused on the early seizure termination. Refractory SE is an indication for sedation in patients with SE, but up to 75% of patients may be ventilated due to a neurological or respiratory failure. In patients requiring sedation, the clinical assessment is not sufficient to assess seizure control. Identifying those at risk of recurrent seizures could be useful to adapt their management. On the other hand, patients with low risk could benefit from an early withdrawal of sedation to avoid the impact of inappropriate sedation on outcome.
OBJECTIVE: To determine the prevalence and the predictors of uncontrolled SE and its impact on outcome in patients with generalized convulsive SE (GCSE) requiring mechanical ventilation (MV).
METHODS: We retrospectively included patients admitted to the intensive care unit with GCSE requiring MV. Uncontrolled SE was defined as persistent or recurrent seizures during sedation or within 24hours following withdrawal. A multivariable logistic regression model was used to assess the associated factors.
RESULTS: Uncontrolled SE occurred in 37 out of 220 patients (17%). Persistent seizures at admission, higher SAPS II and central nervous system infection were associated with a higher risk of uncontrolled SE. Acute toxic or metabolic etiologies were associated with a decreased risk of uncontrolled SE. In a supplementary analysis, decrease of albumin blood levels was associated with uncontrolled SE. Uncontrolled SE was associated with a poor functional outcome and mortality at 90 days.
CONCLUSIONS: Seventeen percent of patients with a GCSE requiring MV suffered from uncontrolled SE. Etiology and persistent seizures at admission were the main predictors of uncontrolled SE. Patients with uncontrolled SE had a longer duration of sedation and MV, a poor functional outcome and a higher mortality. Further studies are required to determine the impact of continuous electroencephalogram monitoring on the clinical course.
OBJECTIVE: To determine the prevalence and the predictors of uncontrolled SE and its impact on outcome in patients with generalized convulsive SE (GCSE) requiring mechanical ventilation (MV).
METHODS: We retrospectively included patients admitted to the intensive care unit with GCSE requiring MV. Uncontrolled SE was defined as persistent or recurrent seizures during sedation or within 24hours following withdrawal. A multivariable logistic regression model was used to assess the associated factors.
RESULTS: Uncontrolled SE occurred in 37 out of 220 patients (17%). Persistent seizures at admission, higher SAPS II and central nervous system infection were associated with a higher risk of uncontrolled SE. Acute toxic or metabolic etiologies were associated with a decreased risk of uncontrolled SE. In a supplementary analysis, decrease of albumin blood levels was associated with uncontrolled SE. Uncontrolled SE was associated with a poor functional outcome and mortality at 90 days.
CONCLUSIONS: Seventeen percent of patients with a GCSE requiring MV suffered from uncontrolled SE. Etiology and persistent seizures at admission were the main predictors of uncontrolled SE. Patients with uncontrolled SE had a longer duration of sedation and MV, a poor functional outcome and a higher mortality. Further studies are required to determine the impact of continuous electroencephalogram monitoring on the clinical course.
摘要：
背景：癫痫持续状态（SE）的管理集中在早期癫痫发作终止。难治性SE是SE患者镇静的指征，但高达75%的患者可能因神经或呼吸衰竭而进行通气。需要镇静的患者，临床评估不足以评估癫痫发作控制情况.识别那些有反复发作风险的人可能有助于调整他们的管理。另一方面,低风险患者可从早期停用镇静中获益,以避免不适当的镇静对结局的影响.
目的：确定不受控制的SE的患病率和预测因素及其对需要机械通气（MV）的全身惊厥性SE（GCSE）患者预后的影响。
方法：我们回顾性纳入重症监护病房GCSE患者。未控制的SE定义为镇静期间或停药后24小时内的持续性或复发性癫痫发作。采用多变量logistic回归模型评估相关因素。
结果：220例患者中有37例（17％）发生了未控制的SE。入院时持续发作，较高的SAPSII和中枢神经系统感染与不受控制的SE风险较高相关.急性毒性或代谢性病因与不受控SE风险降低相关。在补充分析中，血白蛋白水平下降与SE失控相关.未控制的SE与90天的不良功能结局和死亡率相关。
结论：17％的需要MV的GCSE患者患有不受控制的SE。病因学和入院时持续发作是不受控SE的主要预测因素。不受控制的SE患者的镇静和MV持续时间更长，不良的功能结果和较高的死亡率。需要进一步的研究来确定连续脑电图监测对临床过程的影响。
目的：确定不受控制的SE的患病率和预测因素及其对需要机械通气（MV）的全身惊厥性SE（GCSE）患者预后的影响。
方法：我们回顾性纳入重症监护病房GCSE患者。未控制的SE定义为镇静期间或停药后24小时内的持续性或复发性癫痫发作。采用多变量logistic回归模型评估相关因素。
结果：220例患者中有37例（17％）发生了未控制的SE。入院时持续发作，较高的SAPSII和中枢神经系统感染与不受控制的SE风险较高相关.急性毒性或代谢性病因与不受控SE风险降低相关。在补充分析中，血白蛋白水平下降与SE失控相关.未控制的SE与90天的不良功能结局和死亡率相关。
结论：17％的需要MV的GCSE患者患有不受控制的SE。病因学和入院时持续发作是不受控SE的主要预测因素。不受控制的SE患者的镇静和MV持续时间更长，不良的功能结果和较高的死亡率。需要进一步的研究来确定连续脑电图监测对临床过程的影响。
