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. 2023 Sep 20;13(9):1411.
doi: 10.3390/jpm13091411.

Integrating Neuromonitoring in Pediatric Emergency Medicine: Exploring Two Options for Point-of-Care Electroencephalogram (pocEEG) via Patient Monitors-A Technical Note

Leopold Simma  1   2 , Fabrizio Romano  3 , Steffen Schmidt  3 , Georgia Ramantani  2   4 , Bigna K Bölsterli  2   5   6
Affiliations

Integrating Neuromonitoring in Pediatric Emergency Medicine: Exploring Two Options for Point-of-Care Electroencephalogram (pocEEG) via Patient Monitors-A Technical Note

Leopold Simma et al. J Pers Med. .

Abstract

Central nervous system (CNS) disorders are among the most frequent presentations in critically ill children. Status epilepticus (SE) is a frequent scenario in the resuscitation bay. In patients with altered mental status, non-convulsive SE (NCSE) is often underrecognized and critically impacts the neurological outcome and duration of hospitalization. An electroencephalogram (EEG) is required to diagnose NCSE. However, standard EEG recordings are time- and staff-intensive, and their availability is limited, especially outside regular working hours. We aimed to improve patient care by developing a simplified EEG recording method, using a reduced lead montage (point-of-care EEG-pocEEG), that is suitable for use in pediatric emergency departments. The objective was to devise a cost-effective unit with low space requirements that fitted the existing technical infrastructure. We present two technical options for clinical pocEEG acquisition using patient monitors (GE Carescape, Philips IntelliVue) that enable data collection for educational and research purposes. A simplified, rapid response EEG like the pocEEG enables neuromonitoring of patients with CNS disorders in pediatric emergency settings, facilitating timely diagnosis and treatment initiation when standard EEG is not readily available.

Keywords: altered mental status; electroencephalogram; emergency department; non-convulsive status epilepticus; pediatric emergency medicine; point-of-care EEG; rapid response EEG; reduced lead electroencephalogram; simplified electroencephalogram; status epilepticus.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure A1
Figure A1
Data storage Philips IntelliVue system MX700. (A) Data port MIB; (B) Dataport with network cable (RJ45 to serial); (C,D) RJ45 to RS232 (grey, female) connector and USB to RS232 connector (black, male).
Figure A2
Figure A2
Screenshot of video pocEEG showing a non-convulsive status epilepticus in an 11-month-old infant; Video pocEEG: simultaneous video recording with Logitech Capture® of the Logitech camera and laptop screen recording of the VitalRecorder software; channels: EEG 1 F7/T5 and EEG 2 F8/T6.
Figure A3
Figure A3
pocEEG tracings on a GE B450 Carescape monitor, normal activity (A) and on a Philips IntelliVue MX550 with seizure activity (B).
Figure A4
Figure A4
EEG module in side port of GE Carescape B450 (A), USB connection ports (blue arrow) at the rear of the GE Carescape B450 for data recording (B); USB cable for data recording, (USB to RS-232 Adapter, UC232A, ATEN, Taiwan; (C)).
Figure 1
Figure 1
Upper panel (A–C) Technical equipment: first solution. Mobile point-of-care EEG (pocEEG) module, constructed using a mobile GE Carescape patient monitor, and a laptop computer mounted to the stand, shown here in frontal (A) and lateral view (B). Video camera on flexible tripod attached to monitor top. (C) Technical equipment: second solution. EEG module installed in the resuscitation bay, with a fixed Philips IntelliVue patient monitor. Lower panel (D): system diagram pocEEG recording; * ATEN USB to serial adapter (USB to RS-232 Adapter, UC232A, ATEN, Taiwan) is used for the GE Carescape system. Philips IntelliVue connection shown in Figure A1.
Figure 2
Figure 2
Electrode placement for point-of-care EEG (pocEEG) recordings; (A) CardinalHealth electrodes; (B) Micro Neolead® electrocardiogram (ECG) electrodes; (C) Natus electrodes; (D) Ambu Neuroline 720® electrodes; (E) Philips Cup electrodes; The electrodes here have been placed on the scalp, corresponding to the positions, F7/8, T5/6, of the international 10–20 system.
Figure 3
Figure 3
Raw EEG and colorcoded spectral array of the two pocEEG channels (F7/8, T5/6) from the GE System recorded with VitalRecorder. (A) Five-minute recording with a self-limiting seizure. (B) Raw EEG and color-coded spectral array prior to the seizure. (C) Bilateral seizure activity. LFF = low frequency filter; HFF = high frequency filter (HFF).
Figure 4
Figure 4
pocEEG recordings via VitalRecorder (mobile GE Carescape option); 14-month-old infant, recorded during sleep, amplitude 250 µV (A) delta-theta activity; (B) beta activity (arrowheads); (C) 4-month-old infant, amplitude 500 µV, bilateral discharges during a self-limiting seizure; (D) 16-month-old infant, amplitude 500 µV, bilateral discharges, febrile non-convulsive status epilepticus; Low frequency filter (LFF) 0.5 Hz, High frequency filter (HFF): 30 Hz.
Figure 5
Figure 5
Visual cognitive aid on headbox for neonatal ECG electrodes (color code—yellow, ear T5/6; red, temple F7/F8; black, forehead; GE EEG module (“headbox”); Kendall neonatal ECG electrodes).
Figure 6
Figure 6
Screenshot of ixTrend Express point-of-care EEG (pocEEG) recording (Philips IntelliVue system) EEG channel 1 (red), EEG Channel 2 (blue); x-axis EEG amplitude in µV; (A) normal activity, 10 s segment; (B) close-up of EEG trace.
See this image and copyright information in PMC

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