Smith, M; Meyfroidt, G; (2018) Focus on the brain and systemic organ systems: when essential interactions become toxic relationships. Intensive Care Medicine , 44 (12) pp. 2263-2266. 10.1007/s00134-018-5439-7.

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Abstract

Acute brain injury outcomes are driven not only by the underlying neurologic pathology but also by non-neurological (systemic) complications. Conversely, systemic illness as the primary process can have deleterious effects on the brain (Fig. 1). Cross-talk between brain and systemic organ systems is a well-known mechanism, but the impact of treatment on these interactions is equally important. For example, while status epilepticus (SE) may lead to permanent neuronal injury and catecholamine-related systemic complications, its treatment may also affect morbidity and mortality. Despite aggressive first-line (benzodiazepines) and second-line (phenytoin/fosphenytoin, levetiracetam) interventions, more than 40% of these patients will progress to refractory SE. This requires treatment with general anesthetics which may lead to systemic complications, including hypotension requiring vasopressors, immunosuppression and ileus. An algorithmic approach to the management of refractory SE designed to rapidly terminate seizures while minimizing the risk of both neurologic and systemic complications has recently been described.

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