Trial reportPloS one2018
Variability in pharmacologically-induced coma for treatment of refractory status epilepticus.
Trial report in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Surgical Interventions for Super-Refractory Status Epilepticus: A Systematic Review.Neurocritical care · 2026Pooled it
- Diagnosis, treatment, and outcome prediction of non-convulsive status epilepticus in unconscious patients in intensive care units.Neurological research and practice · 2025Review
- The Origin of the Burst-Suppression Paradigm in Treatment of Status Epilepticus.Neurocritical care · 2024Article
- Sustained effort network for treatment of status epilepticus/European academy of neurology registry on adult refractory status epilepticus (SENSE-II/AROUSE).BMC neurology · 2024Article
- Modulatory dynamics mark the transition between anesthetic states of unconsciousness.Proceedings of the National Academy of Sciences of the United States of America · 2023Article
- Association Between Induced Burst Suppression and Clinical Outcomes in Patients With Refractory Status Epilepticus: A 9-Year Cohort Study.Neurology · 2023Article
- Processed Electroencephalogram-Based Monitoring to Guide Sedation in Critically Ill Adult Patients: Recommendations from an International Expert Panel-Based Consensus.Neurocritical care · 2023Article
- Duration of constant rate infusion with diazepam or propofol for canine cluster seizures and status epilepticus.Frontiers in veterinary science · 2023Article
- Recent applications of quantitative electroencephalography in adult intensive care units: a comprehensive review.Journal of neurology · 2022Review
- Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus.Clinical neurophysiology practice · 2021Article
- Etiology of Burst Suppression EEG Patterns.Frontiers in psychology · 2021Article
- Refractory and Super-refractory Status Epilepticus.Indian pediatrics · 2020Review
- Anesthetics in status epilepticus: does one size fits it all?-A scoping review on titration goals, timing, and patient selection.Frontiers in neurologyReview
- To Wean or Not to Wean: Machine Learning to the Rescue.Epilepsy currentsArticle
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveTo characterize the amount of EEG suppression achieved in refractory status epilepticus (RSE) patients treated with pharmacologically-induced coma (PIC).
methodsWe analyzed EEG recordings from 35 RSE patients between 21-84 years-old who received PIC that target burst suppression and quantified the amount of EEG suppression using the burst suppression probability (BSP). Then we measured the variability of BSPs with respect to a reference level of BSP 0.8 ± 0.15. Finally, we also measured the variability of BSPs with respect to the amount of intravenous anesthetic drugs (IVADs) received by the patients.
resultsPatients remained in the reference BSP range for only 8% (median, interquartile range IQR [0, 29] %) of the total time under treatment. The median time with BSP below the reference range was 84% (IQR [37, 100] %). BSPs in some patients drifted significantly over time despite constant infusion rates of IVADs. Similar weight-normalized infusion rates of IVADs in different patients nearly always resulted in distinct BSPs (probability 0.93 (IQR [0.82, 1.0]).
conclusionThis study quantitatively identified high variability in the amount of EEG suppression achieved in clinical practice when treating RSE patients. While some of this variability may arise from clinicians purposefully deviating from clinical practice guidelines, our results show that the high variability also arises in part from significant inter- and intra- individual pharmacokinetic/pharmacodynamic variation. Our results indicate that the delicate balance between maintaining sufficient EEG suppression in RSE patients and minimizing IVAD exposure in clinical practice is challenging to achieve. This may affect patient outcomes and confound studies seeking to determine an optimal amount of EEG suppression for treatment of RSE. Therefore, our analysis points to the need for developing an alternative paradigm, such as vigilant anesthetic management as happens in operating rooms, or closed-loop anesthesia delivery, for investigating and providing induced-coma therapy to RSE patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.