Raoul Christian Sutter

Publications (29) View all

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  Available from: Raoul Christian Sutter

  Chapter: The epidemiology of critical illness brain dysfunction

  Raoul Sutter, Robert D Stevens
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  ABSTRACT: Critically ill patients present with a range of alterations which relate to damage or dysfunction of the central nervous system. Acute brain dysfunction is arguably one of the commonest forms of organ failure in the ICU and is linked directly to adverse short-term outcome. Mounting evidence points to a range of long-term neurologic, cognitive and behavioral changes which substantially impair quality of life following critical illness. Secular trends demonstrate that mortality following severe illnesses such as sepsis and acute respiratory distress syndrome (ARDS) has declined in the past four decades, resulting in a population of long-term ICU survivors with unique characteristics. The purpose of this chapter is to outline the epidemiological features of brain dysfunction in critical illness, distinguishing between acute and post-ICU syndromes.
  09/2013; , ISBN: 9781107029194
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  Chapter: Clinical neurological assessment of the critically ill patient

  Raoul Sutter, Tarek Sharshar, Robert D Stevens
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  ABSTRACT: Neurological assessment of critically ill patients requires physical examination although coexisting cognitive impairment, sedative or paralytic medication, endotracheal intubation, mechanical ventilation, neuromuscular weakness, injuries or surgery involving extracranial tissues may limit sensitivity and specificity of findings. Notwithstanding these constraints, neurological signs and syndromes are valuable indicators of severity of illness and prognosis. Common neurologic syndromes in ICU patients include disturbances in the level of arousal and in cognition, delirium, seizures, generalized weakness, and focal neurological deficits. Whenever possible, neurological examination should include an assessment of mental status, attention, cranial nerves, motor and sensory findings. If there is persisting diagnostic uncertainty additional testing should be sought. Computed tomography of the head should be obtained whenever there is a new onset of seizures, focal neurologic deficits, alteration of mental status or loss of consciousness which are not immediately reversible or explainable. Magnetic resonance imaging has greater sensitivity for demyelinating and inflammatory diseases, hyperacute ischemic stroke, microhemorrhagic lesions, anoxic-ischemic damage, and disorders affecting the white matter and the brainstem. Electroencephalography is needed if seizures or status epilepticus are suspected as a cause or consequence of acute brain dysfunction. Somatosensory evoked potentials, best studied in patients with anoxic brain injury may help with prognostication following cardiac arrest. Electromyography and nerve conduction velocities should be obtained when neuromuscular weakness is severe or cannot be assessed clinically.
  09/2013; , ISBN: 9781107029194
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  Available from: Raoul Christian Sutter

  Article: Calculating the risk benefit equation for aggressive treatment of nonconvulsive status epilepticus.

  Matthew Ferguson, Matt T. Bianchi, Raoul Sutter, Eric S. Rosenthal, Sydney S. Cash, Peter W. Kaplan, M. Brandon Westover
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  ABSTRACT: Objective: To address the question: does non-convulsive status epilepticus warrant the same aggressive treatment as convulsive status epilepticus? Methods: We used a decision model to evaluate the risks and benefits of treating nonconvulsive status epilepticus with intravenous anesthetics and ICU-level aggressive care. We investigated how the decision to use aggressive versus non-aggressive management for nonconvulsive status epilepticus impacts expected patient outcome for four etiologies: absence epilepsy, discontinued antiepileptic drugs, intraparenchymal hemorrhage, and hypoxic ischemic encephalopathy. Each etiology was defined by distinct values for five key parameters: baseline mortality rate of the inciting etiology; efficacy of non-aggressive treatment in gaining control of seizures; the relative contribution of seizures to overall mortality; the degree of excess disability expected in the case of delayed seizure control; and the mortality risk of aggressive treatment. Results: Non-aggressive treatment was favored for etiologies with low morbidity and mortality such as absence epilepsy and discontinued antiepileptic drugs. The risk of aggressive treatment was only warranted in etiologies where there was significant risk of seizure-induced neurologic damage. In the case of post-anoxic status epilepticus, expected outcomes were poor regardless of the treatment chosen. The favored strategy in each case was determined by strong interactions of all five model parameters. Conclusions: Determination of the optimal management approach to nonconvulsive status epilepticus is complex and is ultimately determined by the inciting etiology.
  Neurocritical Care 04/2013; 18(2):216-227. · 2.47 Impact Factor
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  Article: Predicting outcome in adults with status epilepticus.

  Raoul Sutter, Stephan Ruüegg
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  ABSTRACT: Status epilepticus (SE) is the most serious and life-threatening form of an epileptic seizure because it does not end spontaneously and may last for hours if not days or weeks depending on several factors. Repetitive uncontrolled discharges during SE may harm neurons and eventually lead to neuronal necrosis, apoptosis, and/or permanent dysfunction. Thus, immediate and rigorous treatment tailored to the individual condition is very important. In this context, reliable predictors of SE outcome at an early stage of treatment are essential for optimal therapy and to avoid under- or overtreated SE. The aim of this review is to compile detailed information on the validity and reliability of several clinical features known to determine outcome in SE.
  Zeitschrift für Epileptologie 04/2013; 26:79-84.
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  Conference Proceeding: The neurophysiological types of nonconvulsive status epilepticus - EEG paterns of different phenotypes.

  Raoul Sutter, Peter W Kaplan
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  ABSTRACT: Proceeding from the proposed classification of status epilepticus syndromes by Shorvon in 1994, we performed a systematic search for reports presenting electroencephalographic (EEG) patterns of nonconvulsive status epilepticus (NCSE) on all syndromes in the classification, where possible. Using the online medical search engine PubMed for 22 different search strategies, EEG patterns supporting a diagnosis of NCSE were sought. From a total of 4,328 search results, 123 cases with corresponding EEG patterns could be allocated to underlying epilepsy syndromes. Based on the characteristic EEG patterns found for the different NCSE syndromes, we present a synthesis of the significant EEG morphologies and evolutions in the individual NCSE syndromes.
  The London-Innsbruck colloquium on status epilepticus and acute seizures, Salzburg; 04/2013