期刊
PEDIATRIC CRITICAL CARE MEDICINE
卷 17, 期 10, 页码 968-975出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/PCC.0000000000000900
关键词
all pediatric; anesthetic treatment; critical care; electroencephalogram; status epilepticus
资金
- Fundacion Alfonso Martin Escudero
- HHV6 Foundation
- NIH (National Institute of Neurological Disorders and Stroke) [K23NS076550]
- Epilepsy Foundation of America
- American Epilepsy Society
- Pediatric Epilepsy Research Foundation
- CURE
- Ovation Pharmaceuticals
- King Pharmaceuticals
- PRA International/Eisai
- NIH
- National Institute of Neurological Disorders and Stroke
- Guthy-Jackson Charitable Foundation
- International Rett Syndrome Foundation
- Simons Foundation
- Nancy Lurie Marks Foundation
- Lundbeck and Danny Did Foundation
- Sage Therapeutics
- Epilepsy Therapy Project
- PCORI
- HHV-6 Foundation
- Lundbeck
- Eisai
- Upsher-Smith
- Epilepsy Foundation of America (Targeted Initiative for Health Outcomes) [EF-213583]
- American Epilepsy Society/Epilepsy Foundation of America Infrastructure Award
- AES
- EF
- National Institutes of Health (NIH)
- Boston Children's Hospital
- NICHD [1P30HD40677-01]
- IDDRC at Children's National Medical Center
- NIH, NSF [095998]
- CDC [1 UO1 DP003255-01/1-312-0213144]
- NIH, NINDS [2K12NS052159-06A1]
- Neurological Sciences Academic Development Award
- Prevent West Syndrome
- Infantile Epilepsy Research Foundation [Lundbeck]
- NINDS [1U10NS0865130, 1K23N06512]
- Stroke National Capital Area Network for Research [SCANR]
- PICORI [PPRN-1306-04577]
- Collaborative Patient-Centered Rare Epilepsy Network [REN]
- IPA
- BAND Foundation
- Susan S Spencer Clinical Research Fellowship Ammerican Epilespy Society/American Academy of Neurology
- NINDS Center for SUDEP Research Pilot and Feasibility Award [06857]
- NSF/FIU
- Supernus
- AssureX Health
- Boston Children's Hospital [1, 2]
- Boston Children
- UCB Pharma
- Epilepsy Foundation of America Infrastructure Grant
- Lundbeck [Epilepsy Research grant - ongoing]
- Acorda [Epilepsy Research grant-ongoing]
- Pfizer [Epilepsy Research grant - past]
- UCB [Epilepsy Research grant-past]
- Novartis
- GW Pharma
- Massachusetts Neurological Society
- [RO1. NIH EB 014742-01]
- [PICORE 527]
Objective: To describe pediatric patients with convulsive refractory status epilepticus in whom there is intention to use an IV anesthetic for seizure control. Design: Two-year prospective observational study evaluating patients (age range, 1 mo to 21 yr) with refractory status epilepticus not responding to two antiepileptic drug classes and treated with continuous infusion of anesthetic agent. Setting: Nine pediatric hospitals in the United States. Patients: In a cohort of 111 patients with refractory status epilepticus (median age, 3.7 yr; 50% male), 54 (49%) underwent continuous infusion of anesthetic treatment. Main Results: The median (interquartile range) ICU length of stay was 10 (3-20) days. Up to four cycles of serial anesthetic therapy were used, and seizure termination was achieved in 94% by the second cycle. Seizure duration in controlled patients was 5.9 (1.9-34) hours for the first cycle and longer when a second cycle was required (30 [4-120] hr; p = 0.048). Midazolam was the most frequent first-line anesthetic agent (78%); pentobarbital was the most frequently used second-line agent after midazolam failure (82%). An electroencephalographic endpoint was used in over half of the patients; higher midazolam dosing was used with a burst suppression endpoint. In midazolam nonresponders, transition to a second agent occurred after a median of 1 day. Most patients (94%) experienced seizure termination with these two therapies. Conclusions: Midazolam and pentobarbital remain the mainstay of continuous infusion therapy for refractory status epilepticus in the pediatric patient. The majority of patients experience seizure termination within a median of 30 hours. These data have implications for the design and feasibility of future intervention trials. That is, testing a new anesthetic anticonvulsant after failure of both midazolam and pentobarbital is unlikely to be feasible in a pediatric study, whereas a decision to test an alternative to pentobarbital, after midazolam failure, may be possible in a multicenter multinational study.
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