■印度儿科癫痫持续状态(PSE)管理指南的治疗实践和依从性调查。
■本电子调查进行了35天(2023年10月15日至11月20日),包括与医院环境有关的问题;抗癫痫药物(ASM);辅助治疗;可用设施;病因;以及对PSE管理指南的遵守情况。
■共有170名受访者参加,其中大多数在三级医院(94.1%)担任儿科重症医师(56.5%)和儿科医生(19.4%),并在临床实践中2-10年(46.5%)。大多数人使用静脉注射(IV)咪达唑仑和左乙拉西坦作为一线和二线ASM(67.1%和51.2%,分别)。在难治性癫痫持续状态(RSE)的病例中,最常用的ASM是咪达唑仑输注(92.4%).对于超难治性癫痫持续状态(SRSE),常用的三线ASM包括咪达唑仑输注(34.1%),硫喷酮输注(26.5%),高剂量苯巴比妥(18.2%),和氯胺酮输注(15.3%)。总的来说,在有SRSE的情况下,44.7%的受访者使用氯胺酮输液,42.5%使用口服托吡酯,和34.7%使用高剂量苯巴比妥(1-3mg/kg/小时)输注。大多数受访者针对临床和脑电图癫痫发作控制(48.8%)。用于SRSE的辅助治疗包括静脉注射吡哆醇(57.1%),甲基强的松龙(45.3%),IVIG(42.4%),生酮饮食(40.6%),和二线免疫调节(33.5%)。最常见的原因是高热SE,病毒性脑炎,和发热性疾病相关的癫痫综合征(60.6%,52.4%,和37.1%,分别)。可用的设施包括儿科重症监护病房(PICU)(97.1%),机械通气(98.2%),儿科神经科医生(68.8%),MRI脑部(86.5%),脑电图(69.4%),和病毒PCR(58.2%)。对ASM启动时间指南的依从性为63.5%至88.8%。
■静脉注射咪达唑仑,左乙拉西坦,和咪达唑仑输注通常首先使用-,第二-,和三线ASM,分别。在RSE和SRSE中使用ASM的差异很大,辅助治疗,并遵守PSE管理指南。
■SutharR,AnguranaSK,NallasamyK,班萨尔A,MuralidharanJ.儿科癫痫持续状态治疗实践和对管理指南的依从性调查(Pedi-SPECTRUM电子调查)。印度J暴击护理中心2024;28(5):504-510。
UNASSIGNED: Survey of treatment practices and adherence to pediatric status epilepticus (PSE) management
guidelines in India.
UNASSIGNED: This eSurvey was conducted over 35 days (15th October to 20th November 2023) and included questions related to hospital setting; antiseizure medications (ASMs); ancillary treatment; facilities available; etiology; and adherence to PSE management guidelines.
UNASSIGNED: A total of 170 respondents participated, majority of them were working in tertiary level hospitals (94.1%) as pediatric intensivists (56.5%) and pediatricians (19.4%), and were in clinical practice for 2-10 years (46.5%). Majority use intravenous (IV)
midazolam and levetiracetam as first- and second-line ASMs (67.1 and 51.2%, respectively). In cases with refractory status epilepticus (RSE), the most commonly used ASM is
midazolam infusion (92.4%). For super-refractory status epilepticus (SRSE), the commonly used third-line ASMs include midazolam infusion (34.1%), thiopentone infusion (26.5%), high dose phenobarbitone (18.2%), and ketamine infusion (15.3%). Overall, in cases with SRSE, 44.7% respondents use ketamine infusion, 42.5% use add-on oral topiramate, and 34.7% use high-dose phenobarbitone (1-3 mg/kg/hour) infusion. Most respondents targeted both clinical and EEG seizure control (48.8%). Ancillary treatment used for SRSE included IV pyridoxine (57.1%), methylprednisolone (45.3%), IVIG (42.4%), ketogenic diet (40.6%), and second-line immunomodulation (33.5%). Most common causes were febrile SE, viral encephalitis, and febrile illness-related epilepsy syndrome (60.6%, 52.4%, and 37.1%, respectively). Facilities available included pediatric intensive care units (PICU) (97.1%), mechanical ventilation (98.2%), pediatric neurologist (68.8%), MRI brain (86.5%), EEG (69.4%), and viral PCR (58.2%). The compliance with
guidelines for timing of initiation of ASM ranged from 63.5 to 88.8%.
UNASSIGNED: Intravenous
midazolam bolus/es, levetiracetam, and
midazolam infusion are commonly used first-, second-, and third-line ASMs, respectively. There were wide variations in use of ASMs for RSE and SRSE, ancillary treatment, and compliance to PSE management guidelines.
UNASSIGNED: Suthar R, Angurana SK, Nallasamy K, Bansal A, Muralidharan J. Survey of Pediatric Status Epilepticus Treatment Practices and Adherence to Management Guidelines (Pedi-SPECTRUM e-Survey). Indian J Crit Care Med 2024;28(5):504-510.