Status epilepticus: impact of therapeutic coma on outcome.

Détails

Ressource 1Télécharger: 25654177.pdf (575.69 [Ko])
Etat: Serval
Version: Author's accepted manuscript
ID Serval
serval:BIB_86CB92A9BF75
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Status epilepticus: impact of therapeutic coma on outcome.
Périodique
Critical Care Medicine
Auteur(s)
Marchi N.A., Novy J., Faouzi M., Stähli C., Burnand B., Rossetti A.O.
ISSN
1530-0293 (Electronic)
ISSN-L
0090-3493
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
43
Numéro
5
Pages
1003-1009
Langue
anglais
Notes
Publication types: Journal Article Publication Status: ppublish
Résumé
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.
Pubmed
Web of science
Création de la notice
19/02/2015 17:52
Dernière modification de la notice
03/03/2018 19:00
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