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Continuous Electroencephalographic Monitoring in Critically Ill Patients: Indications, Limitations, and Strategies*

Sutter, Raoul MD1–4; Stevens, Robert D. MD1–5; Kaplan, Peter W. MBBS, FRCP2,4

doi: 10.1097/CCM.0b013e318275882f
Review Article

Objective: Continuous electroencephalography as a bedside monitor of cerebral activity has been used in a range of critically ill patients. This review compiles the indications, limitations, and strategies for continuous electroencephalography in the ICU.

Data Source: The authors searched the electronic MEDLINE database.

Study Selection and Data Extraction: References from articles of special interest were selected.

Data Synthesis and Conclusion: Electroencephalographically–defined suppression is routinely used as the basis for titration of pharmacologic therapy in refractory status epilepticus and intracranial hypertension. The increasing use of continuous electroencephalography reveals a clinically underappreciated burden of epileptiform and epileptic activity in patients with primary acute neurologic disorders, and also in critically ill patients with acquired encephalopathy. Status epilepticus is reported with continuous electroencephalography in 1% to 10% of patients with ischemic stroke, 8% to 14% with traumatic brain injury, 10% to 14% with subarachnoid hemorrhage, 1% to 21% with intracerebral hemorrhage, and 30% of patients following cardiorespiratory arrest. These figures underscore the importance of continuous electroencephalography in the critically ill. The interpretation of continuous electroencephalography in the ICU is challenged by electroencephalography artifacts and the frequent subtle differences between ictal and interictal patterns.

1 Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.

2 Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.

3 Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.

4 Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD.

5 Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.

*See also p. 1162.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: rsutter3@jhmi.edu or sutterr@uhbs.ch

This study was performed at the Johns Hopkins University School of Medicine.

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins