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12 Comparison of induction agents for rapid sequence intubation in refractory status epilepticus

OBJECTIVES/GOALS: Multiple induction agents can facilitate rapid sequence intubation (RSI) in management of refractory status epilepticus (rSE), many which have anti-seizure properties. We examine the anti-seizure efficacy and safety of induction agents used during RSI in the management of rSE. METH...

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Autores principales: Woodward, Matthew, Schleicher, Samantha, Podell, Jamie, Chang, Wan-Tsu, Motta, Melissa, Pergakis, Melissa, Parikh, Gunjan, Badjatia, Neeraj, Morris, Nicholas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2023
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10129486/
http://dx.doi.org/10.1017/cts.2023.113
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author Woodward, Matthew
Schleicher, Samantha
Podell, Jamie
Chang, Wan-Tsu
Motta, Melissa
Pergakis, Melissa
Parikh, Gunjan
Badjatia, Neeraj
Morris, Nicholas
author_facet Woodward, Matthew
Schleicher, Samantha
Podell, Jamie
Chang, Wan-Tsu
Motta, Melissa
Pergakis, Melissa
Parikh, Gunjan
Badjatia, Neeraj
Morris, Nicholas
author_sort Woodward, Matthew
collection PubMed
description OBJECTIVES/GOALS: Multiple induction agents can facilitate rapid sequence intubation (RSI) in management of refractory status epilepticus (rSE), many which have anti-seizure properties. We examine the anti-seizure efficacy and safety of induction agents used during RSI in the management of rSE. METHODS/STUDY POPULATION: We conducted a single-center retrospective review of patients admitted to the neuro-ICU intubated for management of rSE. Propofol, ketamine and benzodiazepines were considered anti-seizure medication (ASMs), etomidate was not. Patients were treated with propofol or midazolam following intubation. Our primary outcome was clinical or electrographic recurrence of SE within 12 hours of intubation. Exploratory outcomes included time to recover command following, duration of mechanical ventilation (MV) and complications related to intubation. We used multivariable logistical regression to evaluate outcomes between patients induced with ASMs and etomidate. A Fisher exact test was used to compare rSE cessation in a subset of patients with continuous electroencephalography (cEEG) at the time of intubation. RESULTS/ANTICIPATED RESULTS: We identified 149 induced for RSI in management of rSE: 88 patients intubated using ASMs (propofol,n=56; ketamine,n=14; benzodiazepines,n=18) and 61 patients intubated with etomidate. Forty-one patients had recurrence (29.9% ASMS, 24.6% etomidate). The induction agent was not associated with recurrence of SE, time to command following, or duration of MV. Twenty-seven patients had cEEG monitoring at the time of intubation. Sixteen of the 22 patients induced with ASMs had cessation of rSE with induction, while 1 of 5 intubated with etomidate had cessation (Fisher exact test, p=0.047). There were 34 patients with post-induction hypotension (22.9% ASMs, 22.9% etomidate (Fisher exact test, p=1)). DISCUSSION/SIGNIFICANCE: Induction with an anti-seizure medication during intubation was more likely to halt rSE, but did not decrease the likelihood of clinical or electrographic recurrence of rSE and may not affect time to recovery of command following or duration of MV.
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spelling pubmed-101294862023-04-26 12 Comparison of induction agents for rapid sequence intubation in refractory status epilepticus Woodward, Matthew Schleicher, Samantha Podell, Jamie Chang, Wan-Tsu Motta, Melissa Pergakis, Melissa Parikh, Gunjan Badjatia, Neeraj Morris, Nicholas J Clin Transl Sci Biostatistics, Epidemiology, and Research Design OBJECTIVES/GOALS: Multiple induction agents can facilitate rapid sequence intubation (RSI) in management of refractory status epilepticus (rSE), many which have anti-seizure properties. We examine the anti-seizure efficacy and safety of induction agents used during RSI in the management of rSE. METHODS/STUDY POPULATION: We conducted a single-center retrospective review of patients admitted to the neuro-ICU intubated for management of rSE. Propofol, ketamine and benzodiazepines were considered anti-seizure medication (ASMs), etomidate was not. Patients were treated with propofol or midazolam following intubation. Our primary outcome was clinical or electrographic recurrence of SE within 12 hours of intubation. Exploratory outcomes included time to recover command following, duration of mechanical ventilation (MV) and complications related to intubation. We used multivariable logistical regression to evaluate outcomes between patients induced with ASMs and etomidate. A Fisher exact test was used to compare rSE cessation in a subset of patients with continuous electroencephalography (cEEG) at the time of intubation. RESULTS/ANTICIPATED RESULTS: We identified 149 induced for RSI in management of rSE: 88 patients intubated using ASMs (propofol,n=56; ketamine,n=14; benzodiazepines,n=18) and 61 patients intubated with etomidate. Forty-one patients had recurrence (29.9% ASMS, 24.6% etomidate). The induction agent was not associated with recurrence of SE, time to command following, or duration of MV. Twenty-seven patients had cEEG monitoring at the time of intubation. Sixteen of the 22 patients induced with ASMs had cessation of rSE with induction, while 1 of 5 intubated with etomidate had cessation (Fisher exact test, p=0.047). There were 34 patients with post-induction hypotension (22.9% ASMs, 22.9% etomidate (Fisher exact test, p=1)). DISCUSSION/SIGNIFICANCE: Induction with an anti-seizure medication during intubation was more likely to halt rSE, but did not decrease the likelihood of clinical or electrographic recurrence of rSE and may not affect time to recovery of command following or duration of MV. Cambridge University Press 2023-04-24 /pmc/articles/PMC10129486/ http://dx.doi.org/10.1017/cts.2023.113 Text en © The Association for Clinical and Translational Science 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
spellingShingle Biostatistics, Epidemiology, and Research Design
Woodward, Matthew
Schleicher, Samantha
Podell, Jamie
Chang, Wan-Tsu
Motta, Melissa
Pergakis, Melissa
Parikh, Gunjan
Badjatia, Neeraj
Morris, Nicholas
12 Comparison of induction agents for rapid sequence intubation in refractory status epilepticus
title 12 Comparison of induction agents for rapid sequence intubation in refractory status epilepticus
title_full 12 Comparison of induction agents for rapid sequence intubation in refractory status epilepticus
title_fullStr 12 Comparison of induction agents for rapid sequence intubation in refractory status epilepticus
title_full_unstemmed 12 Comparison of induction agents for rapid sequence intubation in refractory status epilepticus
title_short 12 Comparison of induction agents for rapid sequence intubation in refractory status epilepticus
title_sort 12 comparison of induction agents for rapid sequence intubation in refractory status epilepticus
topic Biostatistics, Epidemiology, and Research Design
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10129486/
http://dx.doi.org/10.1017/cts.2023.113
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