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Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM

Claassen, Jan ; Taccone, Fabio ; Horn, Peter ; Holtkamp, Martin ; Stocchetti, Nino ; Oddo, Mauro

In: Intensive Care Medicine, 2013, vol. 39, no. 8, p. 1337-1351

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    Titel
    • Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM
    Autor
    • Claassen, Jan. Department of Neurology, Division of Critical Care Neurology, Columbia University Medical Center, New York, NY, USA
    • Taccone, Fabio. Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
    • Horn, Peter. Department of Neurosurgery, Horst-Schmidt-Klinik, Wiesbaden, Germany
    • Holtkamp, Martin. Department of Neurology, Charité University Medicine, Berlin, Germany
    • Stocchetti, Nino. Department of Anesthesia and Critical Care, Neuroscience ICU, Fondazione IRCCS Cà Granda-Ospedale Policlinico, University of Milan, Milan, Italy
    • Oddo, Mauro. Department of Intensive Care Medicine, Faculty of Biology of Medicine, CHUV-Lausanne University Hospital, 1011, Lausanne, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Intensive Care Medicine, 2013, vol. 39, no. 8, p. 1337-1351. Springer Berlin Heidelberg
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:311261
    Summary
    Objectives: Recommendations for EEG monitoring in the ICU are lacking. The Neurointensive Care Section of the ESICM assembled a multidisciplinary group to establish consensus recommendations on the use of EEG in the ICU. Methods: A systematic review was performed and 42 studies were included. Data were extracted using the PICO approach, including: (a) population, i.e. ICU patients with at least one of the following: traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, stroke, coma after cardiac arrest, septic and metabolic encephalopathy, encephalitis, and status epilepticus; (b) intervention, i.e. EEG monitoring of at least 30min duration; (c) control, i.e. intermittent vs. continuous EEG, as no studies compared patients with a specific clinical condition, with and without EEG monitoring; (d) outcome endpoints, i.e. seizure detection, ischemia detection, and prognostication. After selection, evidence was classified and recommendations developed using the GRADE system. Recommendations: The panel recommends EEG in generalized convulsive status epilepticus and to rule out nonconvulsive seizures in brain-injured patients and in comatose ICU patients without primary brain injury who have unexplained and persistent altered consciousness. We suggest EEG to detect ischemia in comatose patients with subarachnoid hemorrhage and to improve prognostication of coma after cardiac arrest. We recommend continuous over intermittent EEG for refractory status epilepticus and suggest it for patients with status epilepticus and suspected ongoing seizures and for comatose patients with unexplained and persistent altered consciousness. Conclusions: EEG monitoring is an important diagnostic tool for specific indications. Further data are necessary to understand its potential for ischemia assessment and coma prognostication