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

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

Research output: Contribution to journalArticle

172 Citations (Scopus)

Abstract

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 30 min 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.

Original languageEnglish
Pages (from-to)1337-1351
Number of pages15
JournalIntensive Care Medicine
Volume39
Issue number8
DOIs
Publication statusPublished - Aug 2013

Fingerprint

Critical Illness
Electroencephalography
Consensus
Coma
Status Epilepticus
Seizures
Ischemia
Subarachnoid Hemorrhage
Heart Arrest
Consciousness
Metabolic Brain Diseases
Cerebral Hemorrhage
Encephalitis
Brain Injuries
Stroke
Brain
Population

Keywords

  • Cerebral ischemia
  • EEG
  • Intensive care
  • Prognosis
  • Recommendations
  • Seizures

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

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 S.; Horn, Peter; Holtkamp, Martin; Stocchetti, Nino; Oddo, Mauro.

In: Intensive Care Medicine, Vol. 39, No. 8, 08.2013, p. 1337-1351.

Research output: Contribution to journalArticle

Claassen, Jan ; Taccone, Fabio S. ; Horn, Peter ; Holtkamp, Martin ; Stocchetti, Nino ; Oddo, Mauro. / Recommendations on the use of EEG monitoring in critically ill patients : Consensus statement from the neurointensive care section of the ESICM. In: Intensive Care Medicine. 2013 ; Vol. 39, No. 8. pp. 1337-1351.
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