Anti-Seizure Prophylaxis in Critically Ill Patients with Traumatic Brain Injury in an Intensive Care Unit

Sundararajan, K.; D, Milne; Edwards, Suzanne; Mj, Chapman; Shakib, Sepehr

doi:10.1177/0310057x1504300515

Cited by 10 publications

(19 citation statements)

References 26 publications

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“…The nine studies included were all retrospective and published between 1995 and 2020 ( Table 1 ). Four studies were reported from South Australia (SA) [ 5 , 18 , 24 , 25 ], two from Queensland (QLD) [ 26 , 27 ], and one study each from Victoria (VIC) [ 3 ], New South Wales (NSW) [ 4 ] and Tasmania (Tas) [ 10 ]. A total of 2196 cases of dental infection were reported in the nine studies, and the number of cases ranged from 48 to 672 per study ( Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

Dental Infection Requiring Hospitalisation Is a Public Health Problem in Australia: A Systematic Review Demonstrating an Urgent Need for Published Data

et al. 2023

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Background: The aim of this systematic review was to analyse the published literature on dental infections leading to hospitalisations in Australia. It was hoped that understanding the patterns and trends would form a basis for improved preventive and management policies. Methods: An electronic search was performed using Web of Science, Medline via Ovid and Google Scholar. Inclusion and exclusion criteria were applied. The included studies were analysed for demographics, aetiology, management, length of hospital stay and outcome of dental infections requiring hospitalisation. Results: Nine retrospective studies were eligible for inclusion. A total of 2196 cases of dental infections leading to hospitalisations were reported, with a male predominance (55–67%). Mental health issues, illicit substance abuse and immunosuppression were the main associated comorbidities (up to 58%). Dental caries (59–90%) and pericoronitis (10–19%) were the leading causes of dental infections. Empirical antibiotics were utilised in up to 75% of cases prior to hospital presentation. Six mortalities were reported. Conclusions: The available published data show that dental infection is a significant public health problem. However, only general conclusions were possible due to the variably small sample size and data collection that was inconsistent and incomplete across studies. Improved data collection is required to develop policies for prevention and management.

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Section: Resultsmentioning

confidence: 99%

Dental Infection Requiring Hospitalisation Is a Public Health Problem in Australia: A Systematic Review Demonstrating an Urgent Need for Published Data

et al. 2023

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“…(39) Our data were collected in the time period between the two editions of the guidelines. Other recent work reports rates of prophylactic AED use in adults with severe TBI of 15%(40) and in children with severe TBI of 50%. (6) The rate of presumed prophylactic AED use in our cohort was similar to the latter study.…”

Section: Discussionmentioning

confidence: 99%

EEG Monitoring and Antiepileptic Drugs in Children with Severe TBI

et al. 2016

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Introduction Traumatic brain injury (TBI) causes substantial morbidity and mortality in U.S. children. Post-traumatic seizures (PTS) occur in 11-42% of children with severe TBI and are associated with unfavorable outcome. Electroencephalographic (EEG) monitoring may be used to detect PTS and anti-epileptic drugs (AEDs) may be used to treat PTS, but national rates of EEG and AED use are not known. The purpose of this study was to describe the frequency and timing of EEG and AED use in children hospitalized after severe TBI. Methods Retrospective cohort study of 2,165 children at 30 hospitals in a probabilistically linked dataset from the National Trauma Data Bank (NTDB) and the Pediatric Health Information Systems (PHIS) database, 2007-2010. We included children (age < 18 years old at admission) with linked NTDB and PHIS records, severe (Emergency Department [ED] Glasgow Coma Scale [GCS] < 8) TBI, hospital length of stay > 24 hours, and non-missing disposition. The primary outcomes were EEG and AED use. Results Overall, 31.8% of the cohort had EEG monitoring. Of those, 21.8% were monitored on the first hospital day. The median duration of EEG monitoring was 2.0 (IQR: 1.0, 4.0) days. AEDs were prescribed to 52.0% of the cohort, of whom 61.8% received an AED on the first hospital day. The median duration of AED use was 8.0 (IQR: 4.0, 17.0) days. EEG monitoring and AED use were more frequent in children with known risk factors for PTS. EEG monitoring and AED use were not related to hospital TBI volume. Conclusion EEG use is relatively uncommon in children with severe TBI, but AEDs are frequently prescribed. EEG monitoring and AED use are more common in children with known risk factors for PTS.

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“…It thus appears that anticonvulsants are suppressive during the early period following traumatic brain injury (TBI), but are not prophylactic for the time period beyond the first week. The American Academy of Neurology (AAN) [ 29 ] and the Brain Trauma Foundation [ 30 ] advocate prophylactic use of AED only during the first 7 days after a head injury [ 31 , 32 ]. Phenytoin has been shown to decrease the incidence of early post-traumatic seizures [ 30 ] and to be more cost-effective than levetiracetam [ 33 ].…”

Section: Seizure Prevention In the Icumentioning

confidence: 99%

Antiepileptic drugs in critically ill patients

et al. 2018

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BackgroundThe incidence of seizures in intensive care units ranges from 3.3% to 34%. It is therefore often necessary to initiate or continue anticonvulsant drugs in this setting. When a new anticonvulsant is initiated, drug factors, such as onset of action and side effects, and patient factors, such as age, renal, and hepatic function, should be taken into account. It is important to note that the altered physiology of critically ill patients as well as pharmacological and nonpharmacological interventions such as renal replacement therapy, extracorporeal membrane oxygenation, and target temperature management may lead to therapeutic failure or toxicity. This may be even more challenging with the availability of newer antiepileptics where the evidence for their use in critically ill patients is limited.Main bodyThis article reviews the pharmacokinetics and pharmacodynamics of antiepileptics as well as application of these principles when dosing antiepileptics and monitoring serum levels in critically ill patients. The selection of the most appropriate anticonvulsant to treat seizure and status epileptics as well as the prophylactic use of these agents in this setting are also discussed. Drug-drug interactions and the effect of nonpharmacological interventions such as renal replacement therapy, plasma exchange, and extracorporeal membrane oxygenation on anticonvulsant removal are also included.ConclusionOptimal management of antiepileptic drugs in the intensive care unit is challenging given altered physiology, polypharmacy, and nonpharmacological interventions, and requires a multidisciplinary approach where appropriate and timely assessment, diagnosis, treatment, and monitoring plans are in place.

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Anti-Seizure Prophylaxis in Critically Ill Patients with Traumatic Brain Injury in an Intensive Care Unit

Cited by 10 publications

References 26 publications

Dental Infection Requiring Hospitalisation Is a Public Health Problem in Australia: A Systematic Review Demonstrating an Urgent Need for Published Data

Dental Infection Requiring Hospitalisation Is a Public Health Problem in Australia: A Systematic Review Demonstrating an Urgent Need for Published Data

EEG Monitoring and Antiepileptic Drugs in Children with Severe TBI

Antiepileptic drugs in critically ill patients

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