Electroencephalographic monitoring in the pediatric intensive care unit

Abstract

Continuous electroencephalographic (CEEG) monitoring is used with increasing frequency in critically ill children to provide insight into brain function and to identify electrographic seizures. CEEG monitoring use often impacts clinical management, most often by identifying electrographic seizures and status epilepticus. Most electrographic seizures have no clinical correlate, and thus would not be identified without CEEG monitoring. There are increasing data showing that electrographic seizures and electrographic status epilepticus are associated with worse outcome. Seizure identification efficiency may be improved by further development of quantitative electroencephalography trends. This review describes the clinical impact of CEEG data, the epidemiology of electrographic seizures and status epilepticus, the impact of electrographic seizures on outcome, the utility of quantitative electroencephalographic trends for seizure identification, and practical considerations regarding CEEG monitoring.

Figure 1

Appearance of seizures on a 4-hour quantitative EEG display. A) Timing of electrographic seizures identified by review of the raw EEG; B) Color Density Spectral Array (CDSA) trend depicts seizures as bright bands of color; C) Amplitude-integrated EEG (aEEG) trend depicts seizures as elevations in the lower and upper margins of the tracing. Note that not all electrographic seizures identified by raw EEG are equally recognizable on the CDSA or aEEG trends.