Clinic for Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD.
Crit Care Med. 2019 Aug;47(8):1106-1115. doi: 10.1097/CCM.0000000000003828.
Recommendations regarding nutrition during status epilepticus are lacking, and it is unclear whether restriction of calorie intake would result in beneficial effects or potential harm. We thus aimed to investigate associations between daily calorie intake and outcome in adult status epilepticus patients deriving from a 5-year cohort with a systematic and prospective collection of nutritional data.
Retrospective observational study.
Medical ICUs at a tertiary academic medical care center.
Consecutive patients with status epilepticus treated at the ICUs from 2012 to 2016 were included.
None.
All patients with status epilepticus were monitored regarding nutrition support provided according to the guidelines. Relative risks of no return to baseline were estimated by Poisson regression with robust error variance and adjusted for potential confounders. Of 203 patients, 86 (42%) had return to baseline. Metabolic characteristics of patients with and without return to baseline did not differ. Patients without return to baseline received more calories and proteins per status epilepticus day, and increasing nutritional support was associated with ventilator-associated pneumonia (relative risk, 1.19; 95% CI, 1.09-1.28). Multivariable regression analysis revealed significant increases in relative risks for no return to baseline with every percent of days with nutrition (relative risk, 1.35; 95% CI, 1.05-1.74), with every 100 kcal (relative risk, 1.01; 95% CI, 1.002-1.01), and gram of protein intake (relative risk, 1.01; 95% CI, 1.001-1.01) per status epilepticus day, independent of potential confounders (including fatal etiology, duration and severity of status epilepticus, Charlson comorbidity index, and treatment with anesthetics).
Our results indicate that increased calorie intake during status epilepticus is independently associated with unfavorable outcome. These findings require further validation and investigations into potential mediators, such as induction of ketogenesis, immunomodulating effects, and/or reduction of ICU-associated complications, such as infections.
目前缺乏关于癫痫持续状态期间营养的建议，并且不清楚限制热量摄入是否会带来有益效果或潜在危害。因此，我们旨在调查从一个 5 年的队列中获得的成人癫痫持续状态患者的每日卡路里摄入量与结局之间的关联，该队列系统且前瞻性地收集了营养数据。
回顾性观察性研究。
三级学术医疗中心的医疗重症监护病房。
纳入 2012 年至 2016 年在重症监护病房接受治疗的连续癫痫持续状态患者。
无。
所有癫痫持续状态患者均根据指南监测提供的营养支持情况。使用泊松回归和稳健误差方差估计无恢复到基线的相对风险，并调整了潜在混杂因素。203 例患者中，86 例（42%）恢复到基线。有和无恢复到基线的患者的代谢特征无差异。无恢复到基线的患者在癫痫持续状态期间每天接受的卡路里和蛋白质更多，并且增加营养支持与呼吸机相关性肺炎相关（相对风险，1.19；95%置信区间，1.09-1.28）。多变量回归分析显示，在营养天数每增加 1%、每天摄入 100 卡路里、10 克蛋白质时，无恢复到基线的相对风险显著增加（相对风险，1.35；95%置信区间，1.05-1.74），独立于潜在混杂因素（包括致命病因、癫痫持续状态的持续时间和严重程度、Charlson 合并症指数和麻醉剂治疗）。
我们的结果表明，癫痫持续状态期间卡路里摄入量的增加与不良结局独立相关。这些发现需要进一步验证和研究潜在的介质，如酮体生成的诱导、免疫调节作用和/或减少 ICU 相关并发症，如感染。
