Evaluation of phenytoin serum levels following a loading dose in the acute hospital setting

To access publisher's full text version of this article click on the hyperlink belowPURPOSE: Due to the complex pharmacokinetic profiles of phenytoin (PHT) and fosphenytoin (FOS), achieving sustained, targeted serum PHT levels in the first day of use is challenging. METHODS: A population based approach was used to analyze total serum PHT (tPHT) level within 2-24h of PHT/FOS loading with or without supplementary maintenance or additional loading doses among PHT-naïve patients in the acute hospital setting. Adequate tPHT serum level was defined as ≥20μg/mL. RESULTS: Among 494 patients with 545 tPHT serum levels obtained in the first 2-24h after the loading dose (LD), tPHT serum levels of eitherClinical & Translational Science Institute (CTSI) of the University of Rocheste

Continuous EEG Monitoring Predicts a Clinically Meaningful Recovery Among Adult Inpatients

PURPOSE: Continuous EEG (cEEG) monitoring is primarily used for diagnosing seizures and status epilepticus, and for prognostication after cardiorespiratory arrest. The purpose of this study was to investigate whether cEEG could predict survival and meaningful recovery. METHODS: The authors reviewed inpatient cEEG reports obtained between January 2013 and November 2015 and recorded demographics, preadmission modified Rankin Scale, history of preexisting epilepsy, Glasgow Coma Scale for those admitted to the intensive care unit, and EEG data (posterior dominant rhythm, reactivity, epileptiform discharges, seizures, and status epilepticus). Associations between clinical outcomes (death vs. survival or clinically meaningful recovery [inpatient rehabilitation, home-based rehabilitation, or home] vs. other [death, skilled nursing facility]) and cEEG findings were assessed with logistic regression models. P \u3c 0.05 was considered significant. RESULTS: For 218 cEEG reports (197 intensive care unit admits), the presence of at least a unilateral posterior dominant rhythm was associated with survival (odds ratio for death, 0.38; 95% confidence interval, 0.19-0.77; P = 0.01) and with a clinically meaningful outcome (odds ratio, 3.26; 95% confidence interval, 1.79-5.93; P \u3c 0.001); posterior dominant rhythm remained significant after adjusting for preadmission disability. Those with preexisting epilepsy had better odds of a meaningful recovery (odds ratio, 3.31; 95% CI, 1.34-8.17; P = 0.001). Treated seizures and status epilepticus were not associated with a worse mortality (P = 0.6) or disposition (P = 0.6). High Glasgow Coma Scale (≥12) at intensive care unit admission was associated with a clinically meaningful recovery (odds ratio, 16.40; 95% confidence interval, 1.58-170.19; P = 0.02). CONCLUSIONS: Continuous EEG findings can be used to prognosticate survival and functional recovery, and provide guidance in establishing goals of care

Minimum Technical Requirements for Performing Ambulatory EEG

Ambulatory EEG (AEEG) devices offer portable, multichannel, digital EEG recording with or without video in the patient\u27s natural environment. The technology applied for AEEG recording is like the technology for routine EEG and inpatient long-term video-EEG monitoring but designed to be compact and wearable. Computer-based AEEG technology is well-suited to digital recording, signal processing, and visual display. However, acquiring interpretable EEG outside of the hospital setting presents its own technical challenges. Published guidelines have established technical standards for performing routine EEG and inpatient video-EEG monitoring, but technical standards for AEEG are lacking. Therefore, this guideline provides minimal technical standards for the performance of AEEG which are essential to ensure the quality of studies for clinical and research practice. We expect these minimum standards to evolve over time with improved performance and advances in the technology