Intubation in propofol-treated status epilepticus: a cohort study

Area of Science:

• Neuroscience
• Critical Care Medicine
• Pharmacology

Background:

• Status epilepticus (SE) management often involves endotracheal intubation and mechanical ventilation, particularly with anesthetic agents like propofol.
• Our center utilizes sub-anesthetic propofol as a first-line anti-epileptic for SE, aiming to avoid intubation.

Purpose of the Study:

• To evaluate the efficacy of our SE treatment algorithm using sub-anesthetic propofol without intubation.
• To determine if intubation in SE patients treated with propofol improves clinical outcomes.

Main Methods:

• A retrospective review of adult SE patients treated with propofol at a neuro-intensive care unit (2015-2022).
• Primary outcome: survival without new neurological deficits. Secondary outcomes: development of complications.
• Multivariable logistic regression was used to compare outcomes between intubated and non-intubated patients, and by duration of intubation post-propofol.

Main Results:

• 162 SE patients were identified; 44 (17%) were not intubated, 118 (83%) were.
• Overall survival was 85%, with 42% surviving without new neurological deficits.
• Intubation was not associated with improved survival without new deficits (OR=1.34, p=0.655) or reduced complications.
• Prolonged intubation after propofol cessation decreased survival without new neurological deficits (OR=0.016, p=0.042).

Conclusions:

• Sub-anesthetic propofol is a safe and effective first-line SE treatment, potentially avoiding intubation.
• Intubation in this context does not significantly improve outcomes and may worsen them if prolonged.
• These findings suggest a need to reconsider routine intubation in SE and limit its duration.