UvA-DARE (Digital Academic Repository) Seizures and ... · 167 PICU, Cukurova university school of...

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Seizures and intracranial dynamics in Kenyan children with acute non-traumaticencephalopathies

Gwer, S.A.

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Citation for published version (APA):Gwer, S. A. (2012). Seizures and intracranial dynamics in Kenyan children with acute non-traumaticencephalopathies.

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Download date: 07 Feb 2020

PICU, Cukurova university school of medicine, India Participants: Children with non-traumatic encephalopathies N=67

(n = 25) III - Mannitol 0.5g/Kg and HS (n = 20)

Resolution of coma (mean) I = 123 hrs II = 88.6 hrs III = 87.5 hrs (P = 0.004)

and Mannitol) showed better results in relation to duration of coma and mortality. The authors acknowledge the lack of ICP measurement as a disadvantage in their study and conclude that proper timing of treatment requires ICP monitoring.

done. The combined group was categorized into 2; those who received both agents (A) and those who received hypertonic saline after stopping mannitol (B). The outcomes were not similarly grouped. For the purpose of our review, we have excluded this group. It is not clear whether treatment allocation was done randomly or was period specific. The study includes young infants, a group that needs to be analysed separately because they have immature nervous system and patent fontanelle. This also has a bearing on scoring for coma which is one of the outcomes examined.

Peterson 2000[33]

Design : Retrospective Study Setting: USA Participants: Children with traumatic brain injury and ICP>20mmHg N=68

3% HS infusion

Change in ICP No quantitative data is provided on this

Continuous infusion of HS was efficacious and safe for use in managing raised ICP in paediatric TBI.

ICP monitoring was done but quantitative data to show a dose response effect is not provided. Outcome is well examined for but the lack of a comparison group makes it difficult to conclude on effect of HS use on clinical outcome.

Berger 2002[34]

Case report Setting: Paediatric ICU, Johannes Gutenberg university, Germany Participants: 11 and 12 year old children with traumatic brain injury

20% HS and 20% Mannitol

Change in ICP Bolus administration of either agents resulted in reduction in ICP. This reduction was not sustained in a number of occasions.

HS appeared to reduce post-traumatic increased ICP and improve CPP more effectively than comparable amounts of mannitol.

A dose response effect on ICP with use of both osmotic agents is demonstrated but mannitol appears to cause a reduction in CPP.

Randomised(n=88)

Severe malaria* + Acidosis (Base deficit>8)(*Impaired consciouness / respiratory distress)

Assessed for eligibility (n=94 )

Albumin (HAS) (n=44)

Protocol deviation (n=0) Less volume than protocol (n=0)Protocol violationnoneSevere adverse eventsAllergy (n=0)Pulmonary oedema (n=0)Suspected raised ICP (n=0)

Gelofusine (n=44)Protocol violation (n=1)Haemaccel (died)Severe adverse eventsAllergy (n=1)*Pulmonary oedema (n=0)Suspected raised ICP (n=0)

Died (n=1) Neurological sequelae (n=3)Seizures, Seizuires plus hypotonia, quadriplegia

By intention to treat (n=44)Died 1 (2.3%)Sequalae 3/43 (7%)

Per protocol analysis (n=40)Died 1 (2.5%)Sequalae 3/40 (7.5%)

Died (n=7)Neurological sequelae (n=1)Seizuires

By intention to treat (n=44)Died 7 (16%)Sequalae 1/37 (2.7%)

Per protocol (n=40)Died 4 (10%) Sequalae 1/36 (2.8%)

Consent refused (n=6)

Emergency randomisation: subsequently excluded Did not meet inclusion criteria (n=7)Shock + Hb<5g/dl; Gelofusine (died)Shock+ slide negative; Gelofsine (died)Base deficit =7.0, gelofusine (lived)

Albumin x 4 (all survived)