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.
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。