Rethinking Seizure Care Blog

Continuous EEG Monitoring of Adults in the ICU

Posted by RSC Diagnostics on Apr 15, 2022

Doctor holding clipboard with file in hospital room-1

Neurological monitoring often occurs in the intensive care unit, and it can be done through various tools and methods. One of the most common and useful of these tools is electroencephalography (EEG). This is also one of the simpler ways for medical professionals to look into a patient’s cerebral activity. It is simple to record what’s happening in the brain, and it is sensitive to brain structure and function.

A review from 2018 published in Critical Care (Caricato et al.) looked into indications of when to use the monitoring, and how long it should last.

Indications of the Use of EEG

What are some of the best indications for using EEG monitoring? It is recommended that cEEG is used “after seizures, if impaired consciousness persists after initial treatment.” It should also be used “in cases of unexpected alteration of mental status without known acute brain injury,” “when specific EEG patterns are recognized on routine recording: generalized periodic discharges (GPDs), lateralized periodic discharges (LPDs), or bilateral independent periodic discharge (BIPDs).”

Other times it should be used include “in comatose patients after acute brain injury,”, and “when neuromuscular blocking drugs (NMBD) are used in high-risk patients.”

What Should the Duration of cEEG Monitoring Be?

Often, EEGs are not used for as long as they should be. The traditional recordings are usually only half an hour and an hour long. These may not be long enough to get a full understanding of what’s happening in the patient’s brain. cEEG should be started as soon as nonconvulsive seizures are suspected, and they should typically last for at least 24 hours. In some cases, longer or shorter sessions may be more appropriate. It will have to be determined on a case-by-case basis.

What Did the Review Find?

Over the last ten years or so, the use of continuous EEG monitoring has grown in use and popularity amongst doctors. It has become a staple tool in the “multiparametric monitoring of neurocritical care patients.” Many of the early challenges of using EEG have been solved. There is now standard terminology and indications that refer to the same issues, ensuring that everyone using the tool is on the same page.

However, even with the benefits, and the fact that is being used more often, there are still some issues. According to the review from Caricato et al., continuous EEG monitoring is not being used as often as it probably should be. They found that “clinical indications for cEEG are often not followed, and it still represents an underused tool.”

One of the reasons identified for this is that there needs to be a technician available 24/7 to position and verify the electrodes, and a neurophysiologist needs to read the EEG. They went on to say that other articles have found that with a short period of training, it is possible for ICU doctors and nurses to “achieve an acceptable level in solving technical problems and identifying the main EEG patterns.”

The benefits it offers including the fact that it is not invasive, it can be done at the bedside, and that the cost is relatively low help to make it a good option. Following the indications for when to institute cEEG monitoring and continuing to monitor for a long enough time to get real results is important.

Hopefully, more hospitals begin to use this tool, as it can be a major benefit to their patients. It will be possible to identify problems more quickly, which allow the doctors to have more time to initiate a proper treatment.




Topics: Continuous EEG Monitoring