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Review
. 2025 Mar 21;15(1):37.
doi: 10.1186/s13613-025-01436-0.

Management of severe acute encephalopathy in the ICU: an expert consensus statement from the french society of intensive care medicine

Romain Sonneville  1   2 , Eric Azabou  3 , Pierre Bailly  4 , Sarah Benghanem  5 , Gilles De Almeida Cardoso  6 , Pierre Claquin  7 , David Cortier  6 , Augustin Gaudemer  8 , Bertrand Hermann  9 , Pierre Jaquet  10 , Virginie Lambrecq  11 , Camille Legouy  12   13 , Stéphane Legriel  14 , Thomas Rambaud  6 , Benjamin Rohaut  15 , Benjamine Sarton  16 , Stein Silva  16 , Tarek Sharshar  12   13 , Fabio Silvio Taccone  17 , Dominique Vodovar  18   19   20 , Nicolas Weiss  15 , Charles Cerf  6
Affiliations
Review

Management of severe acute encephalopathy in the ICU: an expert consensus statement from the french society of intensive care medicine

Romain Sonneville et al. Ann Intensive Care. .

Abstract

Introduction: Acute encephalopathy in the ICU poses significant diagnostic, therapeutic, and prognostic challenges. Standardized expert guidelines on acute encephalopathy are needed to improve diagnostic methods, therapeutic decisions, and prognostication.

Methods: The experts conducted a review of the literature, analysed it according to the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) methodology and made proposals for guidelines, which were rated by other experts. Only expert opinions with strong agreement were selected.

Results: The synthesis of expert work and the application of the GRADE method resulted in 39 recommendations. Among the 39 formalized recommendations, 1 had a high level of evidence (GRADE 1 +) and 10 had a low level of evidence (GRADE 2 + or 2-). These recommendations describe indication for ICU admission, use of clinical scores and EEG for diagnosis, detection of complications, and prognostication. The remaining 28 recommendations were based on expert consensus. These recomandations describe common indications for blood and CSF studies, neuroimaging, use of neuromonitoring, and provide guidelines for management in the acute phase.

Conclusion: This expert consensus statement aims to provide a structured framework to enhance the consistency and quality of care for ICU patients presenting with acute encephalopathy. By integrating high-quality evidence with expert opinion, it offers a pragmatic approach to addressing the complex nature of acute encephalopathy in the ICU, promoting best practices in patient care and facilitating future research in the field.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: RS received grants from the French Ministry of Health and research funding from LFB. Other authors have no COI to disclose.

Figures

Fig. 1
Fig. 1
Decision algorithm for neuroimaging in the initial phase of severe acute encephalopathy. *In the presence of coma or signs of brainstem involvement, experts suggest conducting both a cranial CT scan and an angio-CT of the circle of Willis polygon to rule out basilar artery occlusion
See this image and copyright information in PMC

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