Introduction
Methods
Definitions
Patient management
Data acquisition
Statistics
Results
Demographics
SRSE n = 31 | RSE n = 116 | Odds ratio (95% CI) | P-value | |
---|---|---|---|---|
Age, years1 | 48 (+/-20) | 61 (+/-17) | 0.96 (0.94, 0.98) | 0.001* |
Women, n (%) | 17 (55) | 78 (67) | ||
Race, n (%) | ||||
White | 15 (48) | 52 (45) | - | - |
Non white | 16 (52) | 64 (55) | - | - |
History of epilepsy, n (%) | 8 (26) | 38 (33) | ||
Etiology, n (%) | ||||
Acute | 16 (52) | 70 (60) | - | - |
Encephalitis | 12 (35) | 13 (11) | 4.35 (1.7, 11.09) | 0.002* |
Intracerebral hemorrhage | 1 (3) | 31 (27) | 0.09 (0.011, 0.69) | 0.021 |
Stroke | 1 (3) | 4 (3) | ||
Toxic-metabolic | 1 (3) | 11 (9) | ||
Traumatic brain injury | 1 (3) | 11 (9) | ||
Progressive | 10 (30) | 35 (30) | - | - |
Neoplasia | 4 (10) | 7 (6) | ||
Degenerative | 1 (3) | 6 (5) | ||
Epilepsy | 5 (16) | 22 (19) | ||
Idiopathic/cryptogenic | 5 (16) | 11 (9) | ||
Catastrophic etiology, n (%) | 8 (26) | NA | - | - |
Length of SE, days2 | 6.5 (4, 11) | NA | - | - |
Type of SE, n (%) | ||||
Convulsive SE | 23 (74) | 66 (57) | ||
NCSE | 8 (26) | 50 (43) |
AED treatment
cIV-PTB treatment
Variable | Number (%) or median (IQR) |
---|---|
Total number of patients | 31 (100%) |
Number of AEDs before pentobarbital | |
3 | 2 (6) |
4 | 8 (26) |
5 | 7 (23) |
6 | 8 (26) |
7 | 4 (13) |
8 | 2 (6) |
Response to pentobarbital, patients | 28 (90) |
Length of pentobarbital drip, days | 6 (3, 14) |
Length of status epilepticus before pentobarbital initiation, days | 6 (2, 10) |
Withdrawal seizure after interruption of pentobarbital, patients | 15 (48) |
Withdrawal seizure requiring pentobarbital restart, patients | 7 (47)1 |
Phenobarbital to wean pentobarbital, patients | 12 (80)1 |
Safety
Side effects | Number of patients (%) |
---|---|
None | 11 (35) |
Ventilator-associated pneumonia | 10 (32) |
Hypotension | 10 (32) |
Urinary tract infection | 4 (13) |
Deep venous thrombosis | 3 (10) |
Ileus | 3 (10) |
Other | 7 (23) |
Outcome
Outcome at discharge | Number of patients (%) |
---|---|
Outcome at discharge | |
Mortality (GOS 1) | 13 (42) |
GOS 1 to 2 | 20 (65) |
GOS 3 | 10 (32) |
GOS 4 to 5 | 1 (3) |
Outcome at 1 year | |
Mortality (GOS 1) | 18 (58) |
GOS 1 to 2 | 23 (74) |
GOS 3 | 5 (16) |
GOS 4 to 5 | 3 (10) |
Discussion
Efficacy
Safety
Outcome
Limitations
Conclusions
Key messages
-
Pentobarbital can be relatively safely used in the ICU environment.
-
Pentobarbital is effective to treat super-refractory status epilepticus.
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Catastrophic etiology was the only variable associated with poor outcome. None of the other variables usually related to outcome in refractory status epilepticus were associated in our cohort with SRSE.