Continuous EEG monitoring in the intensive care unit: Early findings and clinical efficacy

The assessment of the neurocritical care patient involves serial assessment of neurologic status using bedside clinical examination and a variety of p eriodic neurophysiologic testing. Continuous electroencephalographic (CEEG) monitoring in the intensive care unit offers a unique means to track neuro logic function directly and regionally. CEEG is becoming more widespread wi th a growing but small body of literature. The purpose of this paper is to outline the current experience with intensive care unit CEEG monitoring. Th e basic methods and caveats are discussed. We review the underlying rationa le for using CEEG which is that secondary neurologic injury commonly occurs in the intensive care unit and at times is hard to detect. CEEG has a prov en role in detecting secondary injuries, namely seizures and brain ischemia . The basic tenets of establishing clinical effectiveness for CEEG in the I CU are discussed while acknowledging a need for further study of clinical e ffectiveness. We review our initial clinical experience of CEEG in 300 pati ents and outline the clinical efficacy in terms of cost reduction and impro vement in outcome (P < 0.01) using CEEG. Finally, several controversial asp ects of CEEG are enumerated, and the need for additional study to answer th ese pressing questions is presented.