Department of Intensive Care Medicine, University Hospital Basel, Basel, Switzerland.
Department of Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.
Crit Care Med. 2021 Dec 1;49(12):e1241-e1251. doi: 10.1097/CCM.0000000000005212.
To identify early predictors of postictal delirium in adult patients after termination of status epilepticus.
Retrospective study.
ICUs at a Swiss tertiary academic medical center.
Status epilepticus patients treated on the ICUs for longer than 24 hours from 2012 to 2018.
None.
Primary outcome was postictal delirium during post-status epilepticus treatment defined as an Intensive Care Delirium Screening Checklist greater than or equal to 4. Associations with postictal delirium were secondary outcomes. A time-dependent multivariable Cox proportional hazards model was used to identify risks of postictal delirium. It included variables that differed between patients with and without delirium and established risk factors for delirium (age, sex, number of inserted catheters, illness severity [quantified by the Sequential Organ Failure Assessment and Status Epilepticus Severity Score], neurodegenerative disease, dementia, alcohol/drug consumption, infections, coma during status epilepticus, dose of benzodiazepines, anesthetics, and mechanical ventilation).
Among 224 patients, post-status epilepticus Intensive Care Delirium Screening Checklist was increased in 83% with delirium emerging in 55% with a median duration of 2 days (interquartile range 1-3 d). Among all variables, only the history of alcohol and/or drug consumption was associated with increased hazards for delirium in multivariable analyses (hazard ratio = 3.35; 95% CI, 1.53-7.33).
Our study provides first exploratory insights into the risks of postictal delirium in adult status epilepticus patients treated in the ICU. Delirium following status epilepticus is frequent, lasting mostly 2-3 days. Our findings that with the exception of a history of alcohol and/or drug consumption, other risk factors of delirium were not found to be associated with a risk of postictal delirium may be related to the limited sample size and the exploratory nature of our study. Further investigations are needed to investigate the role of established risk factors in other status epilepticus cohorts. In the meantime, our results indicate that the risk of delirium should be especially considered in patients with a history of alcohol and/or drug consumption.
确定成人癫痫持续状态终止后癫痫发作后谵妄的早期预测因素。
回顾性研究。
瑞士一家三级学术医疗中心的 ICU。
2012 年至 2018 年在 ICU 接受治疗超过 24 小时的癫痫持续状态患者。
无。
主要结局是癫痫持续状态后治疗期间出现的癫痫后谵妄，定义为 ICU 意识模糊筛查检查表≥4 分。与癫痫后谵妄相关的是次要结局。采用时间依赖性多变量 Cox 比例风险模型确定癫痫后谵妄的风险。它包括患者之间存在差异的变量和谵妄的既定危险因素（年龄、性别、导管插入数量、疾病严重程度[通过序贯器官衰竭评估和癫痫持续状态严重程度评分量化]、神经退行性疾病、痴呆、酒精/药物使用、感染、癫痫持续状态期间昏迷、苯二氮䓬类药物、麻醉剂和机械通气剂量）。
在 224 名患者中，83%的患者在癫痫持续状态后出现 ICU 意识模糊筛查检查表增加，55%的患者出现谵妄，中位持续时间为 2 天（四分位间距 1-3 d）。在所有变量中，只有酒精和/或药物使用史与多变量分析中谵妄的风险增加相关（风险比=3.35；95%CI，1.53-7.33）。
我们的研究首次探索性地了解了 ICU 治疗的成人癫痫持续状态患者癫痫后谵妄的风险。癫痫持续状态后谵妄很常见，持续时间大多为 2-3 天。除了酒精和/或药物使用史外，我们发现其他谵妄危险因素与癫痫后谵妄风险无关，这可能与我们研究的样本量有限和探索性有关。需要进一步研究以调查其他癫痫持续状态队列中既定危险因素的作用。与此同时，我们的结果表明，在有酒精和/或药物使用史的患者中，应特别考虑谵妄的风险。
