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Continuous electroencephalography in a surgical intensive care unit

Pedro Kurtz| Nicolas Gaspard| Anna Sophia Wahl| Rebecca Marie Bauer| Lawrence J. Hirsch| Hannah Wunsch| Jan Claassen
Original Article
Volume 40, Issue 2 / February , 2014

Pages 228 - 234

Abstract

Purpose

Our aim was to investigate the prevalence, risk factors, and impact on outcome of nonconvulsive seizures (NCSz), nonconvulsive status epilepticus (NCSE), and periodic epileptiform discharges (PEDs) in surgical intensive care unit (SICU) patients with continuous electroencephalography (cEEG) monitoring.

Methods

This was a retrospective study of SICU patients who underwent cEEG monitoring for altered mental status over a 6-year period. We report the frequency of NCSz (including NCSE) and PEDs on cEEG. The primary outcome was death or severe disability at hospital discharge. Multivariable logistic regression was used to identify whether NCSz (including NCSE) and PEDs were independently associated with poor outcome (death, vegetative state or severe disability).

Results

Of 154 patients, the mean age was 64 ± 14 years old, and 40 % were women. The majority of patients were admitted following abdominal surgery (36 %) and liver transplantation (24 %). Sepsis developed in 100 (65 %) patients. Sixteen percent (n = 24) had NCSz [including 5 % (N = 8) with NCSE], and 29 % (N = 45) had PEDs. All eight patients with NCSE were septic. Clinical seizures prior to cEEG and coma were more common among patients who developed NCSz or NCSE compared to patients without NCSz or NCSE (70 vs. 27 %; p < 0.01; 75 vs. 52 %; p = 0.046 and 63 vs. 34 %; p = 0.09, respectively). NCSzs (including NCSE) were independently associated with poor outcome (20 vs. 3 %, OR 10.4, 95 % CI 1.0–53.7; p = 0.039).

Conclusion

In this retrospective study of SICU patients with cEEG monitoring for altered mental status, NCSz and periodic discharges were frequent and NCSz were independently associated with poor outcome. NCSz were more common when clinical seizures occurred before cEEG.

Keywords

References

  1. Claassen J, Mayer SA, Hirsch LJ (2005) Continuous EEG monitoring in patients with subarachnoid hemorrhage. J Clin Neurophysiol 22:92–98
    • View reference on PubMed
    • View reference on publisher's website
  2. Pandharipande P, Cotton BA, Shintani A et al (2007) Motoric subtypes of delirium in mechanically ventilated surgical and trauma intensive care unit patients. Intensive Care Med 33:1726–1731. doi:10.1007/s00134-007-0687-y
  3. Vespa PM, Miller C, McArthur D et al (2007) Nonconvulsive electrographic seizures after traumatic brain injury result in a delayed, prolonged increase in intracranial pressure and metabolic crisis. Crit Care Med 35:2830–2836. doi:10.1097/01.CCM.0000295667.66853.BC
    • View reference on PubMed
    • View reference on publisher's website
  4. Pandharipande P, Cotton BA, Shintani A et al (2008) Prevalence and risk factors for development of delirium in surgical and trauma intensive care unit patients. J Trauma 65:34–41. doi:10.1097/TA.0b013e31814b2c4d
    • View reference on PubMed
    • View reference on publisher's website
  5. Claassen J, Jetté N, Chum F et al (2007) Electrographic seizures and periodic discharges after intracerebral haemorrhage. Neurology 69:1356–1365. doi:10.1212/01.wnl.0000281664.02615.6c
    • View reference on PubMed
    • View reference on publisher's website
  6. Carrera E, Claassen J, Oddo M et al (2008) Continuous electroencephalographic monitoring in critically ill patients with central nervous system infections. Arch Neurol 65:1612–1618. doi:10.1001/archneur.65.12.1612
    • View reference on PubMed
    • View reference on publisher's website
  7. Oddo M, Carrera E, Claassen J et al (2009) Continuous electroencephalography in the medical intensive care unit. Crit Care Med 37:2051–2056. doi:10.1097/CCM.0b013e3181a00604
    • View reference on PubMed
    • View reference on publisher's website
  8. Lat I, McMillian W, Taylor S et al (2009) The impact of delirium on clinical outcomes in mechanically ventilated surgical and trauma patients. Crit Care Med 37:1898–1905. doi:10.1097/CCM.0b013e31819ffe38
    • View reference on PubMed
    • View reference on publisher's website
  9. Kamel H, Betjemann JP, Navi BB et al (2012) Diagnostic yield of electroencephalography in the medical and surgical intensive care unit. Neurocrit Care. doi:10.1007/s12028-012-9736-7
  10. Brown CVRC, Daigle JBJ, Foulkrod KHK et al (2011) Risk factors associated with early reintubation in trauma patients: a prospective observational study. J Trauma 71:32–37. doi:10.1097/TA.0b013e31821e0c6e
    • View reference on publisher's website
  11. Claassen J, Mayer SA, Kowalski RG et al (2004) Detection of electrographic seizures with continuous EEG monitoring in critically ill patients. Neurology 62:1743–1748
    • View reference on PubMed
    • View reference on publisher's website
  12. Young GB, Jordan KG, Doig GS (1996) An assessment of nonconvulsive seizures in the intensive care unit using continuous EEG monitoring: an investigation of variables associated with mortality. Neurology 47:83–89
    • View reference on PubMed
    • View reference on publisher's website
  13. Towne AR, Waterhouse EJ, Boggs JG et al (2000) Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology 54:340–345
    • View reference on PubMed
    • View reference on publisher's website
  14. Vespa PM, O’Phelan K, Shah M et al (2003) Acute seizures after intracerebral haemorrhage: a factor in progressive midline shift and outcome. Neurology 60:1441–1446
    • View reference on PubMed
    • View reference on publisher's website
  15. Hirsch LJ, Claassen J, Mayer SA, Emerson RG (2004) Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs): a common EEG phenomenon in the critically ill. Epilepsia 45:109–123
    • View reference on PubMed
    • View reference on publisher's website
  16. Chong DJ, Hirsch LJ (2005) Which EEG patterns warrant treatment in the critically ill? Reviewing the evidence for treatment of periodic epileptiform discharges and related patterns. J Clin Neurophysiol 22:79–91
    • View reference on PubMed
    • View reference on publisher's website
  17. Vincent JLJ, Moreno RR, Takala JJ et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med 22:707–710
  18. Claassen J, Taccone FS, Horn P et al (2013) Recommendations on the use of EEG monitoring in critically ill patients: consensus statement from the neurointensive care section of the ESICM. Intensive Care Med. doi:10.1007/s00134-013-2938-4
  19. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 1:480–484. doi:10.1016/S0140-6736(75)92830-5
    • View reference on PubMed
    • View reference on publisher's website
  20. Rossetti AO, Oddo M, Logroscino G, Kaplan PW (2010) Prognostication after cardiac arrest and hypothermia: a prospective study. Ann Neurol 67:301–307. doi:10.1002/ana.21984
    • View reference on PubMed
  21. Jette N, Claassen J, Emerson RG, Hirsch LJ (2006) Frequency and predictors of nonconvulsive seizures during continuous electroencephalographic monitoring in critically ill children. Arch Neurol 63:1750–1755. doi:10.1001/archneur.63.12.1750
    • View reference on PubMed
    • View reference on publisher's website
  22. Polito A, Eischwald F, Le Maho A-L et al (2013) Pattern of brain injury in the acute setting of human septic shock. Crit Care 17:R204. doi:10.1186/cc12899
    • View reference on PubMed
    • View reference on publisher's website

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