Continuous electroencephalographic-monitoring in the ICU: an overview of current strengths and future challenges.
OBJECTIVE
In ICUs, numerous physiological parameters are continuously monitored and displayed. Yet, functional monitoring of the organ of primary concern, the brain, is not routinely performed. Despite the benefits of ICU use of continuous electroencephalographic (EEG)-monitoring (cEEG) is increasingly recognized, several issues nevertheless seem to hamper its widespread clinical implementation.


RESULTS
Utilization of ICU cEEG has significantly improved detection and characterization of cerebral pathology, prognostication and clinical management in specific patient groups. Potential solutions to several remaining challenges are currently being established. Descriptive EEG-terminology is evolving, whereas logistical issues are dealt with using telemedicine and quantitative EEG trends, training of nonexpert personnel and development of specialized detection algorithms. These concerted solutions are advancing cEEG-registration towards cEEG-monitoring. Notwithstanding these advances, obstacles such as ambiguous EEG-interpretation and differences in treatment based on EEG-findings need yet to be overcome.


CONCLUSIONS
In selected critically ill patient groups, ICU cEEG has clear benefits over (repeated) standard EEG or no functional brain monitoring at all and if available, cEEG should be used. However, several issues preventing optimal ICU cEEG usage persist and should be further explored.
aDepartment of Clinical Neurophysiology bDepartment of Intensive Care Medicine, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands.
Danny M W
DM
Hilkman
Walther N K A
WN
van Mook
Vivianne H J M
VH
van Kranen-Mastenbroek
D002545:Brain Ischemia / Q000175:diagnosis*; D003422:Critical Care; D016638:Critical Illness; D004569:Electroencephalography / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D007362:Intensive Care Units; D008991:Monitoring, Physiologic / Q000379:methods*; D012640:Seizures / Q000175:diagnosis*; D009626:Terminology as Topic; D016896:Treatment Outcome