Management of Seizures in Critically Ill Patients
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Seizures are common in critically ill patients and can have significant mortality and morbidity. EEG monitoring is important for detecting both clinical and non-convulsive seizures. Managing seizures in critically ill patients is challenging due to organ dysfunctions, drug interactions, and side effects. The goals of treatment are to stop both clinical and subclinical seizures and prevent future seizures.
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DISCUSSION
Overutilization of PPI in non-critically ill hospitalized patients is a known problem in medical practice. Use of PPI has been implicated in number of adverse consequences including but not limited to Clostridium difficile infection, pneumonia, and osteoporosis. In recent studies, PPI was found to be associated with increased in-hospital mortality, increased risk of cardiovascular events, dementia and chronic renal failure (CRF). We studied the magnitude of the problem in our hospital and employed an educational intervention program, which resulted in a significant reduction of inappropriate use of PPI in the hospital.
There were several limitations to our study. This was a retrospective study where we noted a lack of proper documentation for outpatient use of PPI. We also were unable to precisely determine for how long the patients were taking PPI as outpatients. Our intervention included only medical residents (a total of 41), so we excluded data from NPs, hospitalists or PCPs after intervention. As a result, we are unable to determine the effect of the educational intervention on their practice.
CONCLUSION
PPIs have long been considered as relatively harmless drugs. In recent years, it has been implicated in several adverse effects that increases patient morbidity and mortality along with increased healthcare expenditure. Our data shows that proper education and ongoing surveillance, especially during admission and discharge can significantly reduce overutilization of PPI.
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- 1. Management of Seizures in Critically Ill Patients Ade Wijaya, MD November 2017
- 2. Introduction • Seizures are a common occurrence in critically ill patients • Significant mortality and morbidity • Non-convulsive status epilepticus • EEG monitoring Friedman D, Claassen J, Hirsch LJ. Continuous electroencephalogram monitoring in the intensive care unit. Anesth Analg. 2009;109:506–23. Kurtz P, Hanafy KA, Claassen J. Continuous EEG monitoring: is it ready for prime time? Curr Opin Crit Care. 2009;15:99–109 Tesoro, E. P., & Brophy, G. M. (2010). Pharmacological management of seizures and status epilepticus in critically ill patients. Journal of pharmacy practice, 23(5), 441-454.
- 3. The Goals of Treatment • Cessation of seizures both clinical and subclinical • Prevent seizures Tesoro, E. P., & Brophy, G. M. (2010). Pharmacological management of seizures and status epilepticus in critically ill patients. Journal of pharmacy practice, 23(5), 441-454.
- 4. Primary non-pharmacological Management • Secure airways • Oxygenation • Fluid therapy • Vasopressors • Mechanical ventilation • Body cooling Tesoro, E. P., & Brophy, G. M. (2010). Pharmacological management of seizures and status epilepticus in critically ill patients. Journal of pharmacy practice, 23(5), 441-454.
- 5. Choosing AED • Side effects ? • Interaction ? Tesoro, E. P., & Brophy, G. M. (2010). Pharmacological management of seizures and status epilepticus in critically ill patients. Journal of pharmacy practice, 23(5), 441-454.
- 6. Special Conditions in Critically Ill Patients • Hypoalbuminemia protein binding free drugs toxicity ( in AED with high albumin binding) • Parenteral Nutrition & some drugs competitively binding with albumin. • Enteral food interaction with AEDs decreased AEDs absorbtion • Monitoring free drug concentrations • Drugs doses adjustment in Renal or Liver dysfunctions Salih, M. R., Bahari, M. B., & Abd, A. Y. (2010). Selected pharmacokinetic issues of the use of antiepileptic drugs and parenteral nutrition in critically ill patients. Nutrition journal, 9(1), 71.
- 7. Dasgupta A: Usefulness of monitoring free (unbound) concentrations of therapeutic drugs in patient management. Clin Chim Acta 2007, 377:1-13
- 8. Tesoro, E. P., & Brophy, G. M. (2010). Pharmacological management of seizures and status epilepticus in critically ill patients. Journal of pharmacy practice, 23(5), 441-454.
- 9. Summary • Seizures are common in clinically ill patients • EEG monitoring • Difficult to manage • Organ dysfunctions • Drugs interactions • Side effects