Intensive Care Medicine

, Volume 39, Issue 8, pp 1337–1351 | Cite as

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
Systematic Review

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.

Keywords

EEG Intensive care Seizures Cerebral ischemia Prognosis Recommendations 

Notes

Acknowledgments

This report has been endorsed by the European Society of Intensive Care Medicine. Mauro Oddo is Deputy Chair of the Neurointensive Care section of the European Society of Intensive Care Medicine.

Conflicts of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Jan Claassen
    • 1
  • Fabio S. Taccone
    • 2
  • Peter Horn
    • 3
  • Martin Holtkamp
    • 4
  • Nino Stocchetti
    • 5
  • Mauro Oddo
    • 6
  1. 1.Department of Neurology, Division of Critical Care NeurologyColumbia University Medical CenterNew YorkUSA
  2. 2.Department of Intensive Care Medicine, Erasme HospitalUniversité Libre de BruxellesBrusselsBelgium
  3. 3.Department of NeurosurgeryHorst-Schmidt-KlinikWiesbadenGermany
  4. 4.Department of NeurologyCharité University MedicineBerlinGermany
  5. 5.Department of Anesthesia and Critical Care, Neuroscience ICU, Fondazione IRCCS Cà Granda-Ospedale PoliclinicoUniversity of MilanMilanItaly
  6. 6.Department of Intensive Care Medicine, Faculty of Biology of MedicineCHUV-Lausanne University HospitalLausanneSwitzerland

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