Electroencephalogram Monitoring in Critical Care

Rubiños, Clio; Alkhachroum, Ayham; Claassen, Jan

doi:10.1055/s-0040-1719073

Cited by 17 publications

(7 citation statements)

References 59 publications

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“…239,251 An attenuated-featureless background or burst suppression 24 hours after ROSC is considered unfavorable patterns and are associated with poor outcomes, with low false-positives rates. 251,254,255,262 The sensitivity of these patterns decreases over time. 262 There is no pediatric-specific guidance on the optimal timing of EEG for prognostication purposes after cardiac arrest.…”

Section: Cardiac Arrestmentioning

confidence: 99%

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Plante,

Basu,

Gettings

et al. 2024

Semin Neurol

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Currently nearly one-quarter of admissions to pediatric intensive care units (PICUs) worldwide are for neurocritical care diagnoses that are associated with significant morbidity and mortality. Pediatric neurocritical care is a rapidly evolving field with unique challenges due to not only age-related responses to primary neurologic insults and their treatments but also the rarity of pediatric neurocritical care conditions at any given institution. The structure of pediatric neurocritical care services therefore is most commonly a collaborative model where critical care medicine physicians coordinate care and are supported by a multidisciplinary team of pediatric subspecialists, including neurologists. While pediatric neurocritical care lies at the intersection between critical care and the neurosciences, this narrative review focuses on the most common clinical scenarios encountered by pediatric neurologists as consultants in the PICU and synthesizes the recent evidence, best practices, and ongoing research in these cases. We provide an in-depth review of (1) the evaluation and management of abnormal movements (seizures/status epilepticus and status dystonicus); (2) acute weakness and paralysis (focusing on pediatric stroke and select pediatric neuroimmune conditions); (3) neuromonitoring modalities using a pathophysiology-driven approach; (4) neuroprotective strategies for which there is evidence (e.g., pediatric severe traumatic brain injury, post–cardiac arrest care, and ischemic stroke and hemorrhagic stroke); and (5) best practices for neuroprognostication in pediatric traumatic brain injury, cardiac arrest, and disorders of consciousness, with highlights of the 2023 updates on Brain Death/Death by Neurological Criteria. Our review of the current state of pediatric neurocritical care from the viewpoint of what a pediatric neurologist in the PICU needs to know is intended to improve knowledge for providers at the bedside with the goal of better patient care and outcomes.

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Section: Cardiac Arrestmentioning

confidence: 99%

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Plante,

Basu,

Gettings

et al. 2024

Semin Neurol

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“…Electroencephalography was introduced by Hans Berger of Jena, Germany, in 1929, primarily to study brain dysfunction in mental illnesses (Centorrino et al, 2002). Electroencephalogram (EEG) is a tool that enables clinicians to provide continuous brain monitoring and to guide treatment decisions-brain telemetry (Rubinos et al, 2020). EEG is a record of the oscillations of brain electric potentials recorded from perhaps 20 to 256 electrodes attached to the human.…”

Section: Eegmentioning

confidence: 99%

Abnormalities in EEG as migraine marker: a mini review

Ehteshamzad,

Shkreli

2023

JBS

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The electroencephalogram (EEG) records the spontaneous electrical activity of the brain and is useful in diagnosing various brain conditions. It is commonly used in diagnosing epilepsy, Parkinson's disease, Alzheimer's disease, and multiple sclerosis. Recent research has also suggested that EEG can be used to detect migraine, although the findings in this area are still being investigated. The aim of this study is to review the use of EEG in detecting migraine in past and recent investigations. EEG has been used in migraine studies since the early 20th century, and subsequent studies have explored its use in understanding the pathophysiology of migraine and developing new treatments for the condition. Abnormal EEG patterns, including increased theta and delta activity and decreased alpha and beta activity, have been found in migraine patients during attacks. Studies have shown that EEG can be used to detect migraine and identify specific EEG biomarkers of the condition. Resting-state functional connectivity and altered connectivity in the anterior cingulate cortex have been linked to migraine chronification and may predict treatment outcomes in patients with chronic migraine. However, the specificity of EEG in diagnosing migraine is low, and more research is needed to determine its diagnostic utility.

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“…Low values of a processed-EEG index (corresponding to unnecessary deep sedation, burst-suppression or isoelectric EEG) are associated with a higher incidence of delirium and mortality (46). Moreover, processed-EEG monitoring systems can also show the raw EEG traces and spectral quantitative array, allowing clinicians to identify specific electroencephalographic signatures of sedative drugs in addition to the general benefits of raw EEG monitoring (47).…”

Section: Neuromonitoring To Guide Sedationmentioning

confidence: 99%

“…A recent systematic review and metaanalysis (48) included four RCTs and found no benefits of BIS monitoring on the clinical outcomes or resource utilization. A possible explanation of this conflicting and insufficient evidence may rely on the intrinsic limitations of the numerical dimensionless scales of alertness/unconsciousness derived from the electroencephalographic signal (49-51) rather than the electroencephalogram itself which presents a strong neurobiological background supporting its use (47,52) which should be promoted by the validated educational programs (53).…”

Section: Neuromonitoring To Guide Sedationmentioning

confidence: 99%

Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients

et al. 2022

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The clinical approach to sedation in critically ill patients has changed dramatically over the last two decades, moving to a regimen of light or non-sedation associated with adequate analgesia to guarantee the patient’s comfort, active interaction with the environment and family, and early mobilization and assessment of delirium. Although deep sedation (DS) may still be necessary for certain clinical scenarios, it should be limited to strict indications, such as mechanically ventilated patients with Acute Respiratory Distress Syndrome (ARDS), status epilepticus, intracranial hypertension, or those requiring target temperature management. DS, if not indicated, is associated with prolonged duration of mechanical ventilation and ICU stay, and increased mortality. Therefore, continuous monitoring of the level of sedation, especially when associated with the raw EEG data, is important to avoid unnecessary oversedation and to convert a DS strategy to light sedation as soon as possible. The approach to the management of critically ill patients is multidimensional, so targeted sedation should be considered in the context of the ABCDEF bundle, a holistic patient approach. Sedation may interfere with early mobilization and family engagement and may have an impact on delirium assessment and risk. If adequately applied, the ABCDEF bundle allows for a patient-centered, multidimensional, and multi-professional ICU care model to be achieved, with a positive impact on appropriate sedation and patient comfort, along with other important determinants of long-term patient outcomes.

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Electroencephalogram Monitoring in Critical Care

Cited by 17 publications

References 59 publications

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Abnormalities in EEG as migraine marker: a mini review

Seeking the Light in Intensive Care Unit Sedation: The Optimal Sedation Strategy for Critically Ill Patients

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