Continuous electroencephalography in the medical intensive care unit
Continuous electroencephalography in the medical intensive care unit
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DOI：
10.1097/ccm.0b013e3181a00604
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发表时间：
2009-06-01
影响因子：
8.8
通讯作者：
Hirsch, Lawrence J.
中科院分区：
文献类型：
--
作者：
Oddo, Mauro;Carrera, Emmanuel;Hirsch, Lawrence J.
目标。旨在检查无原发性急性神经系统疾病的医疗重症监护病房 (MICU) 患者中电图癫痫发作 (ESZ) 和周期性癫痫样放电 (PED) 的预测因子和预后价值。设计：回顾性研究。设置。大学医院的 MICU。患者。 2004 年 7 月至 2007 年 1 月期间，共有 201 名连续入住 MICU 的患者，没有已知的急性神经损伤，并接受了连续脑电图监测 (cEEG)，以调查可能的癫痫发作或精神状态的变化。干预：无。测量和主要结果。从入住重症监护病房 (ICU) 到 cEEG 的中位时间为 I 天（四分位数范围 1-4）。大多数患者 (60%) 的主要入院诊断为脓毒症，48% 在 cEEG 时处于昏迷状态。 10% (n = 21) 的患者患有 ESZ，17% (n = 34) 患有 PED，5% (n = 10) 两者都有，22% (n = 45) 患有 ESZ 或 PED。大多数 (67%) 患者在 cEEG 期间的癫痫发作纯粹是电图记录（没有可检测到的临床相关性）。脓毒症患者的 ESZ 或 PED 发生率高于非脓毒症患者（32% vs. 9%，p < 0.001）。在多变量分析中，入住 ICU 时的脓毒症是 ESZ 或 PED 的唯一显着预测因素（比值比 4.6，95% 置信区间 1.9-12.7，p = 0.002）。在控制年龄、昏迷和器官功能障碍后，ESZ 或 PED 的存在与出院时死亡或严重残疾相关（ESZ 或 PED 为 89%，如果没有，则为 39%；比值比 19.1，95% 置信区间 6.3-74.6，p < 0.001）。结论：在这项对使用 cEEG 监测的 MICU 患者进行的回顾性研究中，ESZ 和 PED 与死亡或严重残疾相关。常见，主要见于脓毒症患者。癫痫发作主要是非惊厥性的。癫痫发作和周期性放电均与不良预后相关。有必要进行前瞻性研究，以更准确地确定非惊厥性癫痫发作和周期性放电的频率和临床影响，特别是在脓毒症患者中。 （《重症监护医学》2009 年；37：2051-2056）
Objectives. To examine predictors and the prognostic value of electrographic seizures (ESZs) and periodic epileptiform discharges (PEDs) in medical intensive care unit (MICU) patients without a primary acute neurologic condition.Design: Retrospective study.Setting. MICU in a university hospital.Patients. A total of 201 consecutive patients admitted to the MICU between July 2004 and January 2007 without known acute neurologic injury and who underwent continuous electroencephalography monitoring (cEEG) for investigation of possible seizures or changes in mental status.Intervention: None.Measurements and Main Results. Median time from intensive care unit (ICU) admission to cEEG was I day (interquartile range 1-4). The majority of patients (60%) had sepsis as the primary admission diagnosis and 48% were comatose at the time of cEEG. Ten percent (n = 21) of patients had ESZs, 17% (n = 34) had PEDs, 5% (n = 10) had both, and 22% (n = 45) had either ESZs or PEDs. Seizures during cEEG were purely electrographic (no detectable clinical correlate) in the majority (67%) of patients. Patients with sepsis had a higher rate of ESZs or PEDs than those without sepsis (32% vs. 9%, p < 0.001). On multivariable analysis, sepsis at ICU admission was the only significant predictor of ESZs or PEDs (odds ratio 4.6, 95% confidence interval 1.9-12.7, p = 0.002). After controlling for age, coma, and organ dysfunction, the presence of ESZs or PEDs was associated with death or severe disability at hospital discharge (89% with ESZs or PEDs, vs. 39% if not; odds ratio 19.1, 95% confidence interval 6.3-74.6, p < 0.001).Conclusion: In this retrospective study of MICU patients monitored with cEEG, ESZs and PEDs were frequent, predominantly in patients with sepsis. Seizures were mainly nonconvulsive. Both seizures and periodic discharges were associated with poor outcome. Prospective studies are warranted to determine more precisely the frequency and clinical impact of nonconvulsive seizures and periodic discharges, particularly in septic patients. (Crit Care Med 2009; 37:2051-2056)