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Master Thesis

États de mal épileptique convulsifs ventilés à la phase initiale : étude rétrospective multicentrique du taux d’états de mal réfractaires et des modalités de gestion de l’anesthésie générale à la phase précoce en réanimation

Abstract : Convulsive status epilepticus (CSE) frequently requires mechanical ventilation (MV), either for general anesthesia (GA) in case of refractory SE (recommended duration of 24-48h), or for airway protection. Our objective is to evaluate the proportion of refractory generalized CSE (RGCSE) among patients admitted in ICU under MV, to describe early management of GA and prognosis of these patients. This multicenter retrospective study, conducted in four French ICUs between 2014 and 2016, included patients who were intubated before admission in ICU for SE management. Post anoxic SE and acute traumatic brain injuries were excluded. SE characteristics, antiepileptic drugs (AEDs), reason for intubation, GA duration, relapse of SE and complications were studied. Among the 248 files reviewed, 100 were included. Eighty-seven patients had GCSE and 16% of them had RGCSE. The main reason for intubation was coma (58%) and about one third of patients received GA immediately after failure of first line AED, without any second line. Median duration of GA before weaning was 12.25h [5-18.0], without significant difference between RGCSE and non-refractory SE (respectively 12.75h and 12h, p=0.8). Relapse of SE occurred in 7% of cases, and death in 3%. A duration of GA ≤12h before weaning was associated with less complications, without increasing relapse of SE. Morbidity associated with SE may be decreased if the safety of a GA duration ≤12h in RSE is confirmed by prospective data.
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https://dumas.ccsd.cnrs.fr/dumas-02304286
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Submitted on : Thursday, October 3, 2019 - 10:21:12 AM
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Sinead Zeidan. États de mal épileptique convulsifs ventilés à la phase initiale : étude rétrospective multicentrique du taux d’états de mal réfractaires et des modalités de gestion de l’anesthésie générale à la phase précoce en réanimation. Médecine humaine et pathologie. 2018. ⟨dumas-02304286⟩

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