Modified 2HELPS2B Score Predicts Failure to Wean From Anesthetics in Refractory and Super-Refractory Status Epilepticus.

Objectives: Up to 40% of wean attempts from continuous intravenous anesthetic drugs (CIVADs) are associated with status epilepticus (SE) recurrence. Few features are known to be associated with successful wean from CIVADs. The 2HELPS2B score, designed to stratify the risk of electrographic seizures in critically ill patients, could be used for this purpose. Methods: This was a single-center retrospective case-control study of nonanoxic adult patients treated with CIVADs for refractory SE. Clinical and EEG variables were collected. The original and modified 2HELPS2B scores were compared. Results: We included 102 patients. Thirty-six attempts (35%) failed. Failure was associated with a higher STESS (3 [3-5] vs 3 [2-3], p = 0.03), super-refractoriness (81% vs 16%; p < 0.001), longer CIVAD therapy before weaning (37 vs 21 hours, p = 0.028), more CIVADs at the time of weaning [1 (1-2) vs 1 (1-1), p = 0.005), breakthrough seizures any time before the attempt (62% vs 35%, p = 0.025), and electrographic seizures during the hour before the attempt (11% vs 0%, p = 0.014). The modified 2HELPS2B score was more accurate than the original score (AUROC 0.79 [0.74-0.83] vs 0.72 [0.67-0.77]; p = 0.024), and a modified score ≥3 had 95% specificity for failure. Discussion: In patients treated with CIVADs for refractory status epilepticus, a modified 2HELPS2B score could be used to guide weaning from CIVADs.