title: Continuous electroencephalography in a mixed non-neurological intensive care population, an observational study.
abstract: Continuous electroencephalography (cEEG) improves monitoring of the brain in unconscious patients, but implementation at ICU is difficult. The present investigation shows a way to introduce cEEG at an anesthesiological ICU and discusses the first experiences.
  
  
  
  The study analyzed the feasibility of cEEG, assessed the interpretable cEEG time, importance of automatic seizure detection, the incidence of seizures, the predominant background EEG activity, incidence of delirium and mortality.
  
  
  
  Fifty-three cEEGs of 50 patients with a median interpretable length of 24 hours [IQR 20 to 42 hours] were recorded. One patient had status epilepticus, while 5 patients had non-convulsive seizures. Automated seizure detection recognized the status epilepticus and 3 of 10 non-convulsive seizures, however, detected 42 false positive seizures. Predominant background EEG activity was alpha (9%), theta (17%), delta (26%), burst-suppression (17%), and suppressed background activity (30%). EEG activity correlated neither with dosage of analgo-sedative drugs nor with incidence of delirium or mortality.
  
  
  
  Continuous electroencephalography recording is feasible and manageable. Automatic seizure detection was often false negative/positive; therefore, the interpretation of the cEEG should be supported by EEG-trained neurologists. Background EEG activity was not associated with outcome parameters, which suggests that background activity is a poor outcome predictor.
authors.affiliation: Johannes Gutenberg-University Mainz, University Medical Centre, Department of Anesthesiology, Langenbeckstrasse 1, 55131 Mainz, Germany. Electronic address: schrammp@uni-mainz.de.
authors.forename: Patrick
authors.initials: P
authors.lastname: Schramm
authors.affiliation: Johannes Gutenberg-University Mainz, University Medical Centre, Department of Anesthesiology, Langenbeckstrasse 1, 55131 Mainz, Germany. Electronic address: jluczak@students.uni-mainz.de.
authors.forename: Judyta
authors.initials: J
authors.lastname: Luczak
authors.affiliation: Johannes Gutenberg-University Mainz, University Medical Centre, Department of Anesthesiology, Langenbeckstrasse 1, 55131 Mainz, Germany. Electronic address: engelhak@uni-mainz.de.
authors.forename: Kristin
authors.initials: K
authors.lastname: Engelhard
authors.affiliation: Kerckhoff-Hospital, Heart & Brain Research Group, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. Electronic address: jasmin_elshazly@web.de.
authors.forename: Jasmin
authors.initials: J
authors.lastname: El Shazly
authors.affiliation: Justus Liebig-University Giessen, University Hospital, Department of Neurology, Klinikstrasse 33, 35392 Giessen, Germany. Electronic address: Martin.Juenemann@neuro.med.uni-giessen.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Juenemann
authors.affiliation: Justus Liebig-University Giessen, University Hospital, Department of Neurology, Klinikstrasse 33, 35392 Giessen, Germany. Electronic address: Marlene.Tschernatsch@neuro.med.uni-giessen.de.
authors.forename: Marlene
authors.initials: M
authors.lastname: Tschernatsch
mesh_terms: D003422:Critical Care; D004569:Electroencephalography / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology
keywords: Coma; Critical care; Electroencephalography; Non-convulsive seizures; Seizure detection