Ethics roundtable: 'Open-ended ICU care: can we afford it?'

Area of Science:

• Neurology
• Critical Care Medicine

Background:

• Viral encephalitis can lead to severe neurological complications.
• Status epilepticus (SE) is a neurological emergency requiring aggressive management.

Observation:

• A 27-year-old male with viral encephalitis presented with 3 months of refractory status epilepticus.
• He required high-dose anesthetic agents, mechanical ventilation, and supportive care, remaining in burst suppression on electroencephalography (EEG).
• Despite medical interventions, including ketogenic diet and EEG-guided sedation weaning, SE persisted, necessitating ongoing intensive care unit (ICU) management.

Findings:

• Continuous electroencephalography (EEG) monitoring is crucial for managing burst suppression in refractory status epilepticus (SE).
• Magnetic resonance imaging (MRI) revealed cerebral edema but no definitive permanent cortical damage, indicating potential for recovery.
• Despite poor prognosis suggested by literature, continued intensive care offers a possibility for seizure cessation.

Implications:

• This case underscores the complex management of prolonged, refractory status epilepticus.
• It highlights the importance of multidisciplinary care in critical neurological conditions.
• The case suggests that even in severe, prolonged SE, an open-ended intensive care approach may be warranted due to the possibility of spontaneous resolution.