Continuous electroencephalography in the medical intensive care unit.

Détails

ID Serval
serval:BIB_72FE103D51C3
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Continuous electroencephalography in the medical intensive care unit.
Périodique
Critical Care Medicine
Auteur(s)
Oddo M., Carrera E., Claassen J., Mayer S.A., Hirsch L.J.
ISSN
1530-0293[electronic]
Statut éditorial
Publié
Date de publication
2009
Peer-reviewed
Oui
Volume
37
Numéro
6
Pages
2051-2056
Langue
anglais
Résumé
OBJECTIVES: To examine predictors and the prognostic value of electrographic seizures (ESZs) and periodic epileptiform discharges (PEDs) in medical intensive care unit (MICU) patients without a primary acute neurologic condition. DESIGN: Retrospective study. SETTING: MICU in a university hospital. PATIENTS: A total of 201 consecutive patients admitted to the MICU between July 2004 and January 2007 without known acute neurologic injury and who underwent continuous electroencephalography monitoring (cEEG) for investigation of possible seizures or changes in mental status. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: Median time from intensive care unit (ICU) admission to cEEG was 1 day (interquartile range 1-4). The majority of patients (60%) had sepsis as the primary admission diagnosis and 48% were comatose at the time of cEEG. Ten percent (n = 21) of patients had ESZs, 17% (n = 34) had PEDs, 5% (n = 10) had both, and 22% (n = 45) had either ESZs or PEDs. Seizures during cEEG were purely electrographic (no detectable clinical correlate) in the majority (67%) of patients. Patients with sepsis had a higher rate of ESZs or PEDs than those without sepsis (32% vs. 9%, p < 0.001). On multivariable analysis, sepsis at ICU admission was the only significant predictor of ESZs or PEDs (odds ratio 4.6, 95% confidence interval 1.9-12.7, p = 0.002). After controlling for age, coma, and organ dysfunction, the presence of ESZs or PEDs was associated with death or severe disability at hospital discharge (89% with ESZs or PEDs, vs. 39% if not; odds ratio 19.1, 95% confidence interval 6.3-74.6, p < 0.001). CONCLUSION: In this retrospective study of MICU patients monitored with cEEG, ESZs and PEDs were frequent, predominantly in patients with sepsis. Seizures were mainly nonconvulsive. Both seizures and periodic discharges were associated with poor outcome. Prospective studies are warranted to determine more precisely the frequency and clinical impact of nonconvulsive seizures and periodic discharges, particularly in septic patients.
Mots-clé
Aged, Brain Diseases/diagnosis, Brain Diseases/etiology, Electroencephalography/methods, Female, Humans, Intensive Care Units, Male, Middle Aged, Prognosis, Retrospective Studies, Seizures/diagnosis, Seizures/etiology, Sepsis/complications, Sepsis/physiopathology
Pubmed
Web of science
Création de la notice
09/12/2009 12:28
Dernière modification de la notice
20/08/2019 14:31
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