Status epilepticus: impact of therapeutic coma on outcome.

TitreStatus epilepticus: impact of therapeutic coma on outcome.
Publication TypeJournal Article
Year of Publication2015
AuthorsMarchi, NA, Novy, J, Faouzi, M, Stähli, C, Burnand, B, Rossetti, AO
JournalCritical Care Medicine
Volume43
Issue5
Pagination1003-1009
Date Published05/2015
DOI10.1097/CCM.0000000000000881
ISSN1530-0293 (Electronic)
Mots-clésAcademic Medical Centers, Adult, Age Factors, Aged, Aged, 80 and over, Comorbidity, Female, Humans, Length of Stay, Male, Middle Aged, Retrospective Studies, Severity of Illness Index, Sex Factors, Socioeconomic Factors, Status Epilepticus, Time Factors, Unconsciousness
Abstract

OBJECTIVES: 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.

DESIGN: Retrospective assessment of a prospectively collected cohort.

SETTING: Academic hospital.

PATIENTS: Consecutive adults with incident status epilepticus lasting greater than or equal to 30 minutes, admitted between 2006 and 2013.

MEASUREMENTS AND MAIN RESULTS: 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.

CONCLUSIONS: 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.

Notes

Publication types: Journal Article Publication Status: ppublish

Alternate URL

http://www.ncbi.nlm.nih.gov/pubmed/25654177?dopt=Abstract

WOS ID (UT)

000353061000026

Alternate JournalCrit. Care Med.
Citation Key / SERVAL ID5776
Peer reviewRefereed
PubMed ID25654177

                         

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