Frontotemporal EEG to guide sedation in COVID-19 related acute respiratory distress syndrome

Michalak, Andrew J.; Mendiratta, Anil; Eliseyev, Andrey; Ramnath, Brian; Chung, Jane; Rasnow, Jarret; Reid, Lawrence; Salerno, Steven; García, Paul S.; Agarwal, Sachin; Roh, David; Park, Soo‐Jin; Bazil, Carl W.; Claassen, Jan

doi:10.1016/j.clinph.2021.01.003

Cited by 9 publications

(9 citation statements)

References 38 publications

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“…Depending on the patient’s behavior, a motoric reaction may be interpreted due to the risk of mistaking spinal reflexes such as swallowing, coughing (sometimes with rearing up in bed), and pressing. Thus, the evaluation of the required deep sedation in severe COVID-19 patients remains difficult, even with the help of EEG [ 20 ]. Future analyses clarifying the effects of neuroinflammation may be warranted by using unprocessed EEG data.…”

Section: Discussionmentioning

confidence: 99%

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Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS

Flinspach

Zinn

Zacharowski

et al. 2022

JCM

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The sedation management of patients with severe COVID-19 is challenging. Processed electroencephalography (pEEG) has already been used for sedation management before COVID-19 in critical care, but its applicability in COVID-19 has not yet been investigated. We performed this prospective observational study to evaluate whether the patient sedation index (PSI) obtained via pEEG may adequately reflect sedation in ventilated COVID-19 patients. Statistical analysis was performed by linear regression analysis with mixed effects. We included data from 49 consecutive patients. None of the patients received neuromuscular blocking agents by the time of the measurement. The mean value of the PSI was 20 (±23). The suppression rate was determined to be 14% (±24%). A deep sedation equivalent to the Richmond Agitation and Sedation Scale of −3 to −4 (correlation expected PSI 25–50) in bedside examination was noted in 79.4% of the recordings. Linear regression analysis revealed a significant correlation between the sedative dosages of propofol, midazolam, clonidine, and sufentanil (p < 0.01) and the sedation index. Our results showed a distinct discrepancy between the RASS and the determined PSI. However, it remains unclear to what extent any discrepancy is due to the electrophysiological effects of neuroinflammation in terms of pEEG alteration, to the misinterpretation of spinal or vegetative reflexes during bedside evaluation, or to other causes.

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Section: Discussionmentioning

confidence: 99%

“…So far, alternatives to RASS have been evaluated in assessing sedation depth or cerebral activity by using encephalography (EEG) in a small number of patients [ 20 , 21 ]. The assessment of an adequate sedation depth using EEG in intensive care units has already been demonstrated [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS

Flinspach

Zinn

Zacharowski

et al. 2022

JCM

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“…Since it has been recognized that even a short period of time is associated with adverse outcomes, we design out intervention to evaluate the SR every 2h and reduce the propofol infusion rate if this was over 2% (39). In a cohort of 11 patients with severe ARDS with COVID-19, the authors found that 58% of the frontal EEG evaluations performed by an epileptologist showed an excessive sedation pattern (40). Thus, improving brain monitoring with an intensified algorithm under these circumstances might minimize the occurrence of excessive sedation and its potential deleterious consequences.…”

Section: Discussionmentioning

confidence: 99%

Electroencephalography spectral edge frequency and suppression rate-guided sedation in patients with COVID-19: A randomized controlled trial

Tobar¹,

Farías²,

Rojas³

et al. 2022

Front. Med.

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BackgroundSedation in coronavirus disease 2019 (COVID-19) patients has been identified as a major challenge. We aimed to investigate whether the use of a multiparameter electroencephalogram (EEG) protocol to guide sedation in COVID-19 patients would increase the 30-day mechanical ventilation-free days (VFD).MethodsWe conducted a double-blind randomized clinical trial. We included patients with severe pneumonia due to COVID-19 who required mechanical ventilation (MV) and deep sedation. We randomized to the control (n = 25) or multiparameter group (n = 25). Sedation in the intervention group was administered following the standard institutional protocols together with a flow chart designed to reduce the propofol administration dose if the EEG suppression rate was over 2% or the spectral edge frequency 95 (SEF95) was below 10 Hz. We performed an intention-to-treat analysis to evaluate our primary outcome (30-day VFD).ResultsThere was no difference in VFD at day 30 (median: 11 [IQR 0–20] days in the control group vs. 0 [IQR 0–21] days in the BIS multiparameter group, p = 0.87). Among secondary outcomes, we documented a 17% reduction in the total adjusted propofol administered during the first 5 days of the protocol [median: 2.3 (IQR 1.9–2.8) mg/k/h in the control group vs. 1.9(IQR 1.5–2.2) mg/k/h in the MP group, p = 0.005]. This was accompanied by a higher average BIS value in the intervention group throughout the treatment period.ConclusionA sedation protocol guided by multivariate EEG-derived parameters did not increase the 30-day VFD. However, the intervention led to a reduction in total propofol administration.

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“…RRLM-EEG may help evaluate patients under infection control precautions [ 10 , 11 ]. In a small, single-center study conducted in all patient care areas, ten patients in isolation rooms with COVID-19 utilized the RRLM-EEG EEG device to evaluate for status epilepticus compared to a control group of 40 patients with standard EEG monitoring [ 10 ].…”

Section: Other Causes Of Altered Mental Statusmentioning

confidence: 99%

Rapid Response EEG: Current State and Future Directions

Davey

Gupta

et al. 2022

Curr Neurol Neurosci Rep

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Purpose of Review To critically appraise the literature on the application, methods, and advances in emergency electroencephalography (EEG). Recent Findings The development of rapid EEG (rEEG) technologies and other reduced montage approaches, along with advances in machine learning over the past decade, has increased the rate and access to EEG acquisition. These achievements have made EEG in the emergency setting a practical diagnostic technique for detecting seizures, suspected nonconvulsive status epilepticus (NCSE), altered mental status, stroke, and in the setting of sedation. Summary Growing evidence supports using EEG to expedite medical decision-making in the setting of suspected acute neurological injury. This review covers approaches to acquiring EEG in the emergency setting in the adult and pediatric populations. We also cover the clinical impact of this data, the time associated with emergency EEG, and the costs of acquiring EEG in these settings. Finally, we discuss the advances in artificial intelligence for rapid electrophysiological interpretation.

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Frontotemporal EEG to guide sedation in COVID-19 related acute respiratory distress syndrome

Cited by 9 publications

References 38 publications

Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS

Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS

Electroencephalography spectral edge frequency and suppression rate-guided sedation in patients with COVID-19: A randomized controlled trial

Rapid Response EEG: Current State and Future Directions

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