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ICU-Electroencephalogram Unit Improves Outcome in Status Epilepticus Patients: A Retrospective Before-After Study

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Názov: ICU-Electroencephalogram Unit Improves Outcome in Status Epilepticus Patients: A Retrospective Before-After Study
Autori: Misirocchi, Francesco, Quintard, Hervé, Kleinschmidt, Andréas Karl, Schaller, Karl Lothard, Pugin, Jérôme, Seeck, Margitta, De Stefano, Pia
Zdroj: Crit Care Med
Informácie o vydavateľovi: Ovid Technologies (Wolters Kluwer Health), 2024.
Rok vydania: 2024
Predmety: Male, Adult, 616.8, Online Clinical Investigations, Electroencephalography, Status Epilepticus / drug therapy, Middle Aged, Intensive Care Units / organization & administration, Status Epilepticus / diagnosis, Intensive Care Units, 03 medical and health sciences, Status Epilepticus, 0302 clinical medicine, Humans, Female, Hospital Mortality, Status Epilepticus / physiopathology, Electroencephalography / methods, Status Epilepticus / therapy, Switzerland, Retrospective Studies, Aged
Popis: OBJECTIVES: Continuous electroencephalogram (cEEG) monitoring is recommended for status epilepticus (SE) management in ICU but is still underused due to resource limitations and inconclusive evidence regarding its impact on outcome. Furthermore, the term “continuous monitoring” often implies continuous recording with variable intermittent review. The establishment of a dedicated ICU-electroencephalogram unit may fill this gap, allowing cEEG with nearly real-time review and multidisciplinary management collaboration. This study aimed to evaluate the effect of ICU-electroencephalogram unit establishing on SE outcome and management. DESIGN: Single-center retrospective before-after study. SETTING: Neuro-ICU of a Swiss academic tertiary medical care center. PATIENTS: Adult patients treated for nonhypoxic SE between November 1, 2015, and December 31, 2023. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Data from all SE patients were assessed, comparing those treated before and after ICU-electroencephalogram unit introduction. Primary outcomes were return to premorbid neurologic function, ICU mortality, SE duration, and ICU SE management. Secondary outcomes were SE type and etiology. Two hundred seven SE patients were included, 149 (72%) before and 58 (38%) after ICU-electroencephalogram unit establishment. ICU-electroencephalogram unit introduction was associated with increased detection of nonconvulsive SE (p = 0.003) and SE due to acute symptomatic etiology (p = 0.019). Regression analysis considering age, comorbidities, SE etiology, and SE semeiology revealed a higher chance of returning to premorbid neurologic function (p = 0.002), reduced SE duration (p = 0.024), and a shift in SE management with increased use of antiseizure medications (p = 0.007) after ICU-electroencephalogram unit introduction. CONCLUSIONS: Integrating neurology expertise in the ICU setting through the establishment of an ICU-electroencephalogram unit with nearly real-time cEEG review, shortened SE duration, and increased likelihood of returning to premorbid neurologic function, with an increased number of antiseizure medications used. Further studies are warranted to validate these findings and assess long-term prognosis.
Druh dokumentu: Article
Other literature type
Popis súboru: application/pdf
Jazyk: English
ISSN: 1530-0293
0090-3493
DOI: 10.1097/ccm.0000000000006393
Prístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/39120451
Rights: CC BY NC ND
Prístupové číslo: edsair.doi.dedup.....ca39258478fd96a6235536209403bead
Databáza: OpenAIRE
Popis
Abstrakt:OBJECTIVES: Continuous electroencephalogram (cEEG) monitoring is recommended for status epilepticus (SE) management in ICU but is still underused due to resource limitations and inconclusive evidence regarding its impact on outcome. Furthermore, the term “continuous monitoring” often implies continuous recording with variable intermittent review. The establishment of a dedicated ICU-electroencephalogram unit may fill this gap, allowing cEEG with nearly real-time review and multidisciplinary management collaboration. This study aimed to evaluate the effect of ICU-electroencephalogram unit establishing on SE outcome and management. DESIGN: Single-center retrospective before-after study. SETTING: Neuro-ICU of a Swiss academic tertiary medical care center. PATIENTS: Adult patients treated for nonhypoxic SE between November 1, 2015, and December 31, 2023. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Data from all SE patients were assessed, comparing those treated before and after ICU-electroencephalogram unit introduction. Primary outcomes were return to premorbid neurologic function, ICU mortality, SE duration, and ICU SE management. Secondary outcomes were SE type and etiology. Two hundred seven SE patients were included, 149 (72%) before and 58 (38%) after ICU-electroencephalogram unit establishment. ICU-electroencephalogram unit introduction was associated with increased detection of nonconvulsive SE (p = 0.003) and SE due to acute symptomatic etiology (p = 0.019). Regression analysis considering age, comorbidities, SE etiology, and SE semeiology revealed a higher chance of returning to premorbid neurologic function (p = 0.002), reduced SE duration (p = 0.024), and a shift in SE management with increased use of antiseizure medications (p = 0.007) after ICU-electroencephalogram unit introduction. CONCLUSIONS: Integrating neurology expertise in the ICU setting through the establishment of an ICU-electroencephalogram unit with nearly real-time cEEG review, shortened SE duration, and increased likelihood of returning to premorbid neurologic function, with an increased number of antiseizure medications used. Further studies are warranted to validate these findings and assess long-term prognosis.
ISSN:15300293
00903493
DOI:10.1097/ccm.0000000000006393