ImportanceMultiple continuous intravenous anesthetic drugs (CIVADs) are available for the treatment of refractory status epilepticus (RSE). There is a paucity of data comparing the different types of CIVADs used for RSE.ObjectiveTo systematically review and compare outcome measures associated with the initial CIVAD choice in RSE in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Evidence ReviewData sources included English and non-English articles using Embase, MEDLINE, PubMed, and Web of Science (January 1994-June 2023) as well as manual search. Study selection included peer-reviewed studies of 5 or more patients and at least 1 patient older than 12 years with status epilepticus refractory to a benzodiazepine and at least 1 standard antiseizure medication, treated with continuously infused midazolam, ketamine, propofol, pentobarbital, or thiopental. Independent extraction of articles was performed using prespecified data items. The association between outcome variables and CIVAD was examined with an analysis of variance or χ2 test where appropriate. Binary logistic regressions were used to examine the association between outcome variables and CIVAD with etiology, change in mortality over time, electroencephalography (EEG) monitoring (continuous vs intermittent), and treatment goal (seizure vs burst suppression) included as covariates. Risk of bias was addressed by listing the population and type of each study.FindingsA total of 66 studies with 1637 patients were included. Significant differences among CIVAD groups in short-term failure, hypotension, and CIVAD substitution during treatment were observed. Non–epilepsy-related RSE (vs epilepsy-related RSE) was associated with a higher rate of CIVAD substitution (60 of 120 [50.0%] vs 11 of 43 [25.6%]; odds ratio [OR], 3.11; 95% CI, 1.44-7.11; P = .006) and mortality (98 of 227 [43.2%] vs 7 of 63 [11.1%]; OR, 17.0; 95% CI, 4.71-109.35; P < .001). Seizure suppression was associated with mortality (OR, 7.72; 95% CI, 1.77-39.23; P = .005), but only a small subgroup was available for analysis (seizure suppression: 17 of 22 [77.3%] from 3 publications vs burst suppression: 25 of 98 [25.5%] from 12 publications). CIVAD choice and EEG type were not predictors of mortality. Earlier publication year was associated with mortality, although the observation was no longer statistically significant after adjusting SEs for clustering.Conclusions and RelevanceEpilepsy-related RSE was associated with lower mortality compared with other RSE etiologies. A trend of decreasing mortality over time was observed, which may suggest an effect of advances in neurocritical care. The overall data are heterogeneous, which limits definitive conclusions on the choice of optimal initial CIVAD in RSE treatment.

中文翻译：

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持续静脉麻醉药物治疗难治性癫痫持续状态

重要性多种连续静脉麻醉药物 (CIVAD) 可用于治疗难治性癫痫持续状态 (RSE)。比较用于 RSE 的不同类型 CIVAD 的数据很少。目的根据系统审查和荟萃分析指南的首选报告项目，系统审查和比较与 RSE 中最初 CIVAD 选择相关的结果测量。证据审查数据源包括使用 Embase、MEDLINE、PubMed 和 Web of Science（1994 年 1 月至 2023 年 6 月）以及手动检索的英语和非英语文章。研究选择包括对 5 名或更多患者以及至少 1 名年龄超过 12 岁的癫痫持续状态患者进行的同行评审研究，这些患者对苯二氮卓类药物和至少 1 种标准抗癫痫药物难以治疗，并接受持续输注咪达唑仑、氯胺酮、异丙酚、戊巴比妥或硫喷妥钠治疗。使用预先指定的数据项进行文章的独立提取。通过方差或 χ2 分析检查结果变量与 CIVAD 之间的关联2在适当的地方进行测试。使用二元 Logistic 回归来检查结果变量和 CIVAD 之间的关联，其中包括作为协变量的病因、死亡率随时间的变化、脑电图 (EEG) 监测（连续与间歇）和治疗目标（癫痫发作与突发抑制）。通过列出每项研究的人群和类型来解决偏倚风险。结果共纳入 66 项研究，涉及 1637 名患者。观察到 CIVAD 组之间在短期失败、低血压和治疗期间 CIVAD 替代方面存在显着差异。非癫痫相关 RSE（与癫痫相关 RSE 相比）与较高的 CIVAD 替代率相关（120 例中的​​ 60 例 [50.0%] vs 43 例中的 11 例 [25.6%]；比值比 [OR]，3.11；95% CI ，1.44-7.11；磷= .006）和死亡率（227 例中的 98 例 [43.2%] vs 63 例中的 7 例 [11.1%]；OR，17.0；95% CI，4.71-109.35；磷< .001）。癫痫发作抑制与死亡率相关（OR，7.72；95% CI，1.77-39.23；磷= .005），但只有一个小亚组可用于分析（癫痫发作抑制：来自 3 篇出版物的 22 篇文章中的 17 篇 [77.3%]，而突发抑制：来自 12 篇出版物的 98 篇文章中的 25 篇 [25.5%]）。CIVAD 选择和 EEG 类型不是死亡率的预测因素。较早的出版年份与死亡率相关，尽管在调整 SE 进行聚类后，观察结果不再具有统计显着性。结论和相关性与其他 RSE 病因相比，癫痫相关的 RSE 与较低的死亡率相关。观察到死亡率随着时间的推移而下降的趋势，这可能表明神经重症监护的进步产生了影响。总体数据是异质的，这限制了 RSE 治疗中最佳初始 CIVAD 选择的明确结论。