PMID- 24240843
OWN - NLM
STAT- MEDLINE
DCOM- 20150220
LR  - 20220331
IS  - 1432-1238 (Electronic)
IS  - 0342-4642 (Linking)
VI  - 40
IP  - 2
DP  - 2014 Feb
TI  - Continuous electroencephalography in a surgical intensive care unit.
PG  - 228-234
LID - 10.1007/s00134-013-3149-8 [doi]
AB  - PURPOSE: Our aim was to investigate the prevalence, risk factors, and impact on 
      outcome of nonconvulsive seizures (NCSz), nonconvulsive status epilepticus 
      (NCSE), and periodic epileptiform discharges (PEDs) in surgical intensive care 
      unit (SICU) patients with continuous electroencephalography (cEEG) monitoring. 
      METHODS: This was a retrospective study of SICU patients who underwent cEEG 
      monitoring for altered mental status over a 6-year period. We report the 
      frequency of NCSz (including NCSE) and PEDs on cEEG. The primary outcome was 
      death or severe disability at hospital discharge. Multivariable logistic 
      regression was used to identify whether NCSz (including NCSE) and PEDs were 
      independently associated with poor outcome (death, vegetative state or severe 
      disability). RESULTS: Of 154 patients, the mean age was 64 +/- 14 years old, and 
      40% were women. The majority of patients were admitted following abdominal 
      surgery (36%) and liver transplantation (24%). Sepsis developed in 100 (65%) 
      patients. Sixteen percent (n = 24) had NCSz [including 5% (N = 8) with NCSE], and 
      29% (N = 45) had PEDs. All eight patients with NCSE were septic. Clinical 
      seizures prior to cEEG and coma were more common among patients who developed 
      NCSz or NCSE compared to patients without NCSz or NCSE (70 vs. 27%; p < 0.01; 75 
      vs. 52%; p = 0.046 and 63 vs. 34%; p = 0.09, respectively). NCSzs (including 
      NCSE) were independently associated with poor outcome (20 vs. 3%, OR 10.4, 95% CI 
      1.0-53.7; p = 0.039). CONCLUSION: In this retrospective study of SICU patients 
      with cEEG monitoring for altered mental status, NCSz and periodic discharges were 
      frequent and NCSz were independently associated with poor outcome. NCSz were more 
      common when clinical seizures occurred before cEEG.
FAU - Kurtz, Pedro
AU  - Kurtz P
AD  - Division of Critical Care Neurology, Department of Neurology, Columbia 
      University, College of Physicians and Surgeons, New York, NY, USA.
AD  - Department of Intensive Care Medicine, Clinica Sao Vicente, Rua Joao Borges 204, 
      Gavea, Rio de Janeiro, RJ, 22451-100, Brazil.
FAU - Gaspard, Nicolas
AU  - Gaspard N
AD  - Department of Neurology, Comprehensive Epilepsy Center, Yale University, New 
      Haven, CT, USA.
FAU - Wahl, Anna Sophia
AU  - Wahl AS
AD  - Division of Critical Care Neurology, Department of Neurology, Columbia 
      University, College of Physicians and Surgeons, New York, NY, USA.
FAU - Bauer, Rebecca Marie
AU  - Bauer RM
AD  - Department of Anesthesiology, Feinberg School of Medicine, Northwestern 
      University, Chicago, USA.
FAU - Hirsch, Lawrence J
AU  - Hirsch LJ
AD  - Department of Neurology, Comprehensive Epilepsy Center, Yale University, New 
      Haven, CT, USA.
FAU - Wunsch, Hannah
AU  - Wunsch H
AD  - Division of Critical Care, Department of Anesthesiology, Columbia University, 
      College of Physicians and Surgeons, New York, NY, USA.
AD  - Department of Epidemiology, Mailman School of Public Health, Columbia University, 
      New York, NY, USA.
FAU - Claassen, Jan
AU  - Claassen J
AD  - Division of Critical Care Neurology, Department of Neurology, Columbia 
      University, College of Physicians and Surgeons, New York, NY, USA. 
      jc1439@columbia.edu.
LA  - eng
PT  - Journal Article
DEP - 20131116
PL  - United States
TA  - Intensive Care Med
JT  - Intensive care medicine
JID - 7704851
SB  - IM
MH  - Aged
MH  - *Electroencephalography/methods
MH  - Female
MH  - Humans
MH  - Intensive Care Units
MH  - Male
MH  - Middle Aged
MH  - Monitoring, Physiologic/methods
MH  - Postoperative Care/*methods
MH  - Postoperative Complications/*diagnosis/epidemiology
MH  - Prevalence
MH  - Prognosis
MH  - Retrospective Studies
MH  - Seizures/*diagnosis/epidemiology
MH  - Status Epilepticus/*diagnosis/epidemiology
EDAT- 2013/11/19 06:00
MHDA- 2015/02/24 06:00
CRDT- 2013/11/19 06:00
PHST- 2013/07/10 00:00 [received]
PHST- 2013/10/27 00:00 [accepted]
PHST- 2013/11/19 06:00 [entrez]
PHST- 2013/11/19 06:00 [pubmed]
PHST- 2015/02/24 06:00 [medline]
AID - 10.1007/s00134-013-3149-8 [pii]
AID - 10.1007/s00134-013-3149-8 [doi]
PST - ppublish
SO  - Intensive Care Med. 2014 Feb;40(2):228-234. doi: 10.1007/s00134-013-3149-8. Epub 
      2013 Nov 16.