Department of Intensive Care, University Hospital Basel, Basel, Switzerland.
Department of Neurology, University Hospital Basel, Basel, Switzerland.
J Neurol. 2024 Jan;271(1):231-240. doi: 10.1007/s00415-023-11944-3. Epub 2023 Sep 7.
To assess the frequency, clinical features, and outcome of peri-ictal delirium in adult patients experiencing seizures during intensive care.
This observational study was conducted at a Swiss intensive care unit from 2015 to 2020. Patients aged ≥ 18 years with seizures were categorized as peri-ictal delirious (Intensive Care Delirium Screening Checklist [i.e., ICDSC] ≥ 4) or not (i.e., ICDSC < 4) within 24 h of seizures. The frequency of peri-ictal delirium and in-hospital death were defined as the primary endpoints. Illness severity and treatment characteristics between delirious and non-delirious patients were secondary endpoints. Logistic regression was used to compare in-hospital death and differences regarding clinical characteristics between delirious and non-delirious patients.
48% of 200 patients had peri-ictal delirium for a median of 3 days. Delirious patients were older (median age 69 vs. 62 years, p = 0.002), had lower Simplified Acute Physiology Scores II (SAPS II; median 43 vs. 54, p = 0.013), received neuroleptics more frequently (31 vs. 5%, p < 0.001), were mechanically ventilated less often (56% vs. 73%, p = 0.013) and shorter (median 3 vs. 5 days, p = 0.011), and had decreased odds for in-hospital death with delirium (OR = 0.41, 95% CI 0.20-0.84) in multivariable analyses.
Delirium emerged in every second patient experiencing seizures and was associated with lower SAPS II, shorter mechanical ventilation, and better outcomes, contradicting assumptions that altered cerebral function, from seizures and delirium, are linked to unfavorable outcomes.
评估在重症监护期间发生癫痫发作的成年患者中，围发作性谵妄的频率、临床特征和结局。
这项观察性研究于 2015 年至 2020 年在瑞士的一家重症监护病房进行。将年龄≥18 岁且有癫痫发作的患者在癫痫发作后 24 小时内分为围发作性谵妄（即，重症监护谵妄筛查检查表 [即，ICDSC]≥4）或非谵妄（即，ICDSC<4）。围发作性谵妄和院内死亡的频率被定义为主要终点。疾病严重程度和治疗特征是次要终点。逻辑回归用于比较谵妄和非谵妄患者的院内死亡和临床特征差异。
200 例患者中有 48%出现围发作性谵妄，中位时间为 3 天。谵妄患者年龄更大（中位数 69 岁 vs. 62 岁，p=0.002），简化急性生理学评分 II （SAPS II；中位数 43 分 vs. 54 分，p=0.013）较低，更频繁地使用神经阻滞剂（31% vs. 5%，p<0.001），较少接受机械通气（56% vs. 73%，p=0.013）且时间更短（中位数 3 天 vs. 5 天，p=0.011），并且在多变量分析中，谵妄与院内死亡的几率降低（OR=0.41，95%CI 0.20-0.84）。
在每两个经历癫痫发作的患者中就有一个出现谵妄，并且与较低的 SAPS II、较短的机械通气和更好的结局相关，这与从癫痫发作和谵妄中改变大脑功能与不良结局相关的假设相矛盾。
