Abstract
The patient is a 27-year-old previously healthy male with a diagnosis of viral encephalitis with a lymphocytic pleocytosis on cerebrospinal fluid examination. For 3 months, he has been in status epilepticus (SE) on high doses of barbiturates, benzodiazepines, and ketamine and a ketogenic feeding-tube formula. He remains in burst suppression on continuous electroencephalography (EEG). He is trached and has a percutaneous endoscopic gastrostomy (PEG) feeding tube. He has been treated several times for pneumonia, and he is on a warming blanket and is on vasopressors to maintain his blood pressure. His vitals are stable and his lab work is within limits. The sedation is decreased under EEG guidance every 72 hours, after which he goes back into SE and heavy sedation is resumed. The latest magnetic resonance imaging (MRI) shows edema but otherwise no obvious permanent cortical damage. The family wants a realistic assessment of the likely outcome. The neurologist tells them the literature suggests the outlook is poor but not 100% fatal. As long as all of his other organs are functioning on life support, there is always a chance the seizures will stop at some time in the future, and so the neurologist recommends an open-ended intensive care unit (ICU) plan and hopes for that outcome.
Highlights
The patient is a 27-year-old previously healthy male with a diagnosis of viral encephalitis with a lymphocytic pleocytosis on cerebrospinal fluid examination
Since it is difficult to know on admission which patients will benefit from life-supporting organ failure reversal, we admit all comers for a trial
Before we can conclude that withdrawal of organ support is appropriate, a number of actions are required: 1. A multi-disciplinary team (MDT) discussion about this very difficult case should occur between neurology, critical care, neurophysiology, and infectious diseases
Summary
The patient is a 27-year-old previously healthy male with a diagnosis of viral encephalitis with a lymphocytic pleocytosis on cerebrospinal fluid examination. The unique situation of critical care will create a double dip for each patient maintained on artificial life support. Since it is difficult to know on admission which patients will benefit from life-supporting organ failure reversal, we admit all comers for a trial.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have