2015年6月4日文献精读摘要

作者：TeachingAssistant 来源：日期：2015/6/11 0:00:35 人气：

Crit Care. 2015 Apr 30;19(1):199. doi: 10.1186/s13054-015-0914-9.

Functional outcome of prolonged refractory status epilepticus.

Lai A1, Outin HD2, Jabot J3, Mégarbane B4, Gaudry S5,6, Coudroy R7, Louis G8, Schneider F9, Barbarot N10, Roch A11, Lerolle N12, Luis D13, Fourrier F14, Renault A15, Argaud L16, Sharshar T17, Gibot S18, Bollaert PE19.

INTRODUCTION:

To characterize etiology, clinical course and outcomes of patients in prolonged refractory status epilepticus (PRSE) and looking for prognostic factors.

METHODS:

Retrospective study conducted in patients hospitalized from January 1, 2001 to December 31, 2011 in 19 polyvalent intensive care units in French university and general hospitals. Patients were adults with a generalized convulsive refractory status epilepticus that lasted more than seven days, despite treatment including an anesthetic drug and mechanical ventilation. Patients with anoxic encephalopathy were excluded. Follow-up phone call was used to determine functional outcome using modified Rankin Scale (mRS) with mRS 0-3 defining good and mRS 4-6 poor outcome.

RESULTS:

78 patients (35 female) were included. Median age was 57 years. Causes of status epilepticus were various, mainly including prior epilepsy (14.1%), CNS infection (12.8%), and stroke (12.8%). No etiology was found in 27 (34.6%) patients. PRSE was considered controlled in only 53 (67.9%) patients after a median duration of 17 (IQR 12-26) days. The median length of ICU stay was 28 (19-48) days. Forty-one (52.5%) patients died in the ICU, 26 from multiple organ failure, 8 from care withdrawal, 2 from sudden cardiac arrest, 1 from brain death and 4 from unknown causes. PRSE was previously resolved in 20 patients who died in the ICU. At one-year follow-up, there were 12 patients with good outcome and 58 with poor outcome and 8 lost of follow-up. On multivariate analysis, only vasopressor use was a predictor of poor outcome (OR 6.54; 95%CI 1.09-39.29; p = 0.04).

CONCLUSION:

Poor outcome was observed in about 80% of this population of PRSE. Most patients died from systemic complications linked to their ICU stay. Some patients can recover satisfactorily over time though we did not identify any robust factor of good outcome.

PMID: 25925042

全文链接：http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4426536/

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2015年6月4日文献精读摘要

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