From the Clinic for Intensive Care Medicine (R.S., S.M.) and the Division of Clinical Neurophysiology, Department of Neurology (R.S., P.F., S.R.), University Hospital Basel, Switzerland; the Division of Neurosciences Critical Care (R.S.), Department of Anesthesiology, Critical Care Medicine and Neurology, Johns Hopkins University School of Medicine, Baltimore; and the Department of Neurology (R.S., P.W.K.), Johns Hopkins Bayview Medical Center, Baltimore, MD.
Neurology. 2014 Feb 25;82(8):656-64. doi: 10.1212/WNL.0000000000000009. Epub 2013 Dec 6.
To evaluate the risks of continuously administered IV anesthetic drugs (IVADs) on the outcome of adult patients with status epilepticus (SE).
All intensive care unit patients with SE from 2005 to 2011 at a tertiary academic medical care center were included. Relative risks were calculated for the primary outcome measures of seizure control, Glasgow Outcome Scale score at discharge, and death. Poisson regression models were used to control for possible confounders and to assess effect modification.
Of 171 patients, 37% were treated with IVADs. Mortality was 18%. Patients with anesthetic drugs had more infections during SE (43% vs 11%; p < 0.0001) and a 2.9-fold relative risk for death (2.88; 95% confidence interval 1.45-5.73), independent of possible confounders (i.e., duration and severity of SE, nonanesthetic third-line antiepileptic drugs, and critical medical conditions) and without significant effect modification by different grades of SE severity and etiologies. As IVADs were used after first- and second-line drugs failed, there was a correlation between treatment-refractory SE and the use of IVADs, leading to insignificant results regarding the risk of IVADs and outcome after additional adjustment for refractory SE.
Our findings heighten awareness regarding adverse effects of IVADs. Randomized controlled trials are needed to further clarify the association of IVADs with outcome in patients with SE.
This study provides Class III evidence that patients with SE receiving IVADs have a higher proportion of infection and an increased risk of death as compared to patients not receiving IVADs.
评估连续静脉给予麻醉药物（IVADs）对成人癫痫持续状态（SE）患者结局的影响。
纳入 2005 年至 2011 年期间在一家三级学术医疗中心接受 SE 治疗的所有重症监护病房患者。计算了主要结局指标（癫痫控制、出院时格拉斯哥结局量表评分和死亡）的相对风险。采用泊松回归模型来控制可能的混杂因素，并评估效应修饰。
在 171 例患者中，37%的患者接受了 IVAD 治疗。死亡率为 18%。使用麻醉药物的患者在 SE 期间更易发生感染（43%比 11%；p<0.0001），且死亡的相对风险为 2.9 倍（2.88；95%置信区间 1.45-5.73），独立于可能的混杂因素（即 SE 的持续时间和严重程度、非麻醉性三线抗癫痫药物和危急的医疗状况），且不同 SE 严重程度和病因分级无显著的效应修饰。由于 IVAD 是在一线和二线药物治疗失败后使用的，因此治疗抵抗性 SE 与 IVAD 的使用之间存在相关性，因此在进一步调整难治性 SE 后，IVAD 与结局之间的风险关系无显著意义。
我们的发现使人们对 IVAD 的不良影响有了更深入的认识。需要进行随机对照试验来进一步阐明 SE 患者中 IVAD 与结局的关联。
本研究提供了 III 级证据，表明与未接受 IVAD 治疗的患者相比，接受 IVAD 治疗的 SE 患者感染比例更高，死亡风险增加。
