title: Continuous electroencephalographic monitoring in critically ill patients: indications, limitations, and strategies.
abstract: 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.
  
  
  METHODS
  The authors searched the electronic MEDLINE database.
  
  
  METHODS
  References from articles of special interest were selected.
  
  
  CONCLUSIONS
  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.
authors: Division of Neurosciences Critical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. rsutter3@jhmi.edu
authors: Raoul
authors: R
authors: Sutter
authors: Robert D
authors: RD
authors: Stevens
authors: Peter W
authors: PW
authors: Kaplan
mesh_terms: D001927:Brain Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000451:nursing; D002545:Brain Ischemia / Q000175:diagnosis; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000453:epidemiology* / Q000451:nursing; D004569:Electroencephalography / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000175:diagnosis; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008991:Monitoring, Physiologic / Q000379:methods; D013226:Status Epilepticus / Q000175:diagnosis