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Type: Journal article
Title: Anti-seizure prophylaxis in critically ill patients with traumatic brain injury in an intensive care unit
Author: Sundararajan, K.
Milne, D.
Edwards, S.
Chapman, M.
Shakib, S.
Citation: Anaesthesia and Intensive Care, 2015; 43(5):646-651
Publisher: Australian Society of Anaesthetists
Issue Date: 2015
ISSN: 0310-057X
Statement of
K. Sundararajan, D. Milne, S. Edwards, M. J. Chapman, S. Shakib
Abstract: The objectives of this prospective observational study were to determine the proportion of patients with traumatic brain injury who received effective anti-seizure prophylaxis. The study was conducted in a tertiary level ICU of a major trauma referral centre between February 2012 and August 2013. A total of 2361 patients were admitted to the ICU in this study period, of whom125 patients (index) with traumatic head injury were included in this study. The patients had a mean age of 45 years (SD=19), a mean score on the Glasgow Coma Scale of 9 (SD=4), a mean injury severity score of 27 (SD=13) and a mean APACHE III score of 55 (SD=27). Only 13.6 % (17 of 125) of patients were given anti-seizure prophylaxis and phenytoin levels were measured in 9.6% (12 of 125). Although all 12 patients achieved an effective concentration for phenytoin therapy (>40 µmol/l) after the loading dose, no patient had their target concentration consistently maintained in the recommended therapeutic range (40 to 80 µmol/l) throughout the seven-day monitoring period. There was wide fluctuation in phenytoin levels in the patients in this study. Twenty-two (18%) of the index patients had post-traumatic seizures, indicating a high prevalence for this study. Poor compliance with guidelines could possibly explain this phenomenon. Future studies are needed to look at the dosing and monitoring of phenytoin and/or alternative anti-seizure prophylaxis in patients with traumatic brain injury.
Keywords: Intensive care unit; phenytoin; traumatic brain injury; post-traumatic seizures
Rights: © 2015 Anaesthesia and Intensive Care published by the Australian Society of Anaesthetists
DOI: 10.1177/0310057x1504300515
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