Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest

Abend, Nicholas S.; Topjian, Alexis; Ichord, Rebecca; Herman, Susan T.; Helfaer, Mark A.; Donnelly, Maureen; Nadkarni, Vinay; Dlugos, Dennis J.; Clancy, Robert R.

doi:10.1212/wnl.0b013e3181a82687

Cited by 192 publications

(180 citation statements)

References 72 publications

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“…Collectively, these results are an important finding with regard to pharmacotherapy and TTM, namely, that drugs with long halflives, such as phenytoin and fentanyl, when administered to patients undergoing TTM, should continue to be monitored even into the posttreatment period and subsequent dose adjustments should be made accordingly. This is particularly true given that rewarming has been identified as a period of potential heightened hemodynamic and brain instability in brain-injured patients (Hutchison et al, 2008;Abend et al, 2009)…”

Section: Anticonvulsantsmentioning

confidence: 99%

Effect of Hypothermia and Targeted Temperature Management on Drug Disposition and Response Following Cardiac Arrest: A Comprehensive Review of Preclinical and Clinical Investigations

Anderson

Poloyac

Kochanek

et al. 2016

Therapeutic Hypothermia and Temperature Management

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Targeted temperature management (TTM) has been shown to reduce mortality and improve neurological outcomes in out-of-hospital cardiac arrest (CA) patients and in neonates with hypoxic-ischemic encephalopathy (HIE). TTM has also been associated with adverse drug events in the critically ill patient due to its effect on drug pharmacokinetics (PKs) and pharmacodynamics (PDs). We aim to evaluate the current literature on the effect of TTM on drug PKs and PDs following CA. MEDLINE/PubMed databases were searched for publications, which include the MeSH terms hypothermia, drug metabolism, drug transport, P450, critical care, cardiac arrest, hypoxic-ischemic encephalopathy, pharmacokinetics, and pharmacodynamics between July 2006 and October 2015. Twenty-three studies were included in this review. The studies demonstrate that hypothermia impacts PK parameters and increases concentrations of cytochrome-P450-metabolized drugs in the cooling and rewarming phase. Furthermore, the current data demonstrate a combined effect of CA and hypothermia on drug PK. Importantly, these effects can last greater than 4-5 days post-treatment. Limited evidence suggests hypothermia-mediated changes in the Phase II metabolism and the Phase III transport of drugs. Hypothermia also has been shown to potentially decrease the effect of specific drugs at the receptor level. Therapeutic hypothermia, as commonly deployed/applied during TTM, alters PK, and elevates concentrations of several commonly used medications. Hypothermia-mediated effects are an important factor when dosing and monitoring patients undergoing TTM treatment.

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Section: Anticonvulsantsmentioning

confidence: 99%

Effect of Hypothermia and Targeted Temperature Management on Drug Disposition and Response Following Cardiac Arrest: A Comprehensive Review of Preclinical and Clinical Investigations

Anderson

Poloyac

Kochanek

et al. 2016

Therapeutic Hypothermia and Temperature Management

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show abstract

“…Hypoxic ischemic encephalopathy is also associated with a high rate of seizures, affecting 10 to 33% of patients following cardiac arrest [33,34]. Rewarming is a common time for seizures to occur, either because a clinical motoric component (e.g., myoclonic status epilepticus) is revealed after discontinuation of paralytics [34,35], or because sedation or hypothermia suppressed or treated the electrographic activity [35]. In addition to detecting seizures, EEG demonstration of a reactive background rhythm or a continuous pattern on amplitude-integrated EEG had a high likelihood of good neurological prognosis, despite the presence of seizures [36][37][38].…”

Section: Patient Selectionmentioning

confidence: 99%

The Utility of EEG, SSEP, and Other Neurophysiologic Tools to Guide Neurocritical Care

Rosenthal

2012

Neurotherapeutics

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Neuromonitoring is an emerging field that aims to characterize real-time neurophysiology to tailor therapy for acute injuries of the central nervous system. While cardiac telemetry has been used for decades among patients requiring critical care of all kinds, neurophysiology and neurotelemetry has only recently emerged as a routine screening tool in comatose patients. The increasing utilization of electroencephalography in comatose patients is primarily due to the recognition of the common occurrence of nonconvulsive seizures among comatose patients, the development of quantitative measures to detect regional ischemia, and the appreciation of electroencephalography phenotypes that indicate prognosis after cardiac arrest. Other neuromonitoring tools, such as somatosensory evoked potentials have a complementary role, surveying the integrity of the neuroaxis as an indicator of prognosis or illness progression in both acute brain and spinal injuries.

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“…[1][2][3][4][5][6][7][8][9][10][11][12] The majority of electrographic seizures were not accompanied by any clinical signs, 1,3,8,[10][11][12][13][14] even in nonparalyzed patients. 1,14 Therefore, accurate seizure identification requires CEEG.…”

mentioning

confidence: 91%

Electrographic seizures in pediatric ICU patients

et al. 2013

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Objectives: We aimed to determine the incidence of electrographic seizures in children in the pediatric intensive care unit who underwent EEG monitoring, risk factors for electrographic seizures, and whether electrographic seizures were associated with increased odds of mortality.Methods: Eleven sites in North America retrospectively reviewed a total of 550 consecutive children in pediatric intensive care units who underwent EEG monitoring. We collected data on demographics, diagnoses, clinical seizures, mental status at EEG onset, EEG background, interictal epileptiform discharges, electrographic seizures, intensive care unit length of stay, and in-hospital mortality.Results: Electrographic seizures occurred in 162 of 550 subjects (30%), of which 61 subjects (38%) had electrographic status epilepticus. Electrographic seizures were exclusively subclinical in 59 of 162 subjects (36%). A multivariable logistic regression model showed that independent risk factors for electrographic seizures included younger age, clinical seizures prior to EEG monitoring, an abnormal initial EEG background, interictal epileptiform discharges, and a diagnosis of epilepsy. Subjects with electrographic status epilepticus had greater odds of in-hospital death, even after adjusting for EEG background and neurologic diagnosis category.Conclusions: Electrographic seizures are common among children in the pediatric intensive care unit, particularly those with specific risk factors. Electrographic status epilepticus occurs in more than one-third of children with electrographic seizures and is associated with higher in-hospital mortality. Neurology â 2013;81:383-391 GLOSSARY CEEG 5 continuous EEG; CI 5 confidence interval; IQR 5 interquartile range; OR 5 odds ratio; PICU 5 pediatric intensive care unit.

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Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest

Abstract: Background: Hypoxic ischemic brain injury secondary to pediatric cardiac arrest (CA) may result in

Cited by 192 publications

References 72 publications

Effect of Hypothermia and Targeted Temperature Management on Drug Disposition and Response Following Cardiac Arrest: A Comprehensive Review of Preclinical and Clinical Investigations

Effect of Hypothermia and Targeted Temperature Management on Drug Disposition and Response Following Cardiac Arrest: A Comprehensive Review of Preclinical and Clinical Investigations

The Utility of EEG, SSEP, and Other Neurophysiologic Tools to Guide Neurocritical Care

Electrographic seizures in pediatric ICU patients

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