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Electrophysiologic Monitoring in the Intensive Care Unit

Published online by Cambridge University Press:  12 November 2018

Rosamund A. Hill  and
Keith H. Chiappa
Rosamund A. Hill
Affiliation:
EEG/EP Laboratory, Massachusetts General Hospital, Boston
Keith H. Chiappa*
Affiliation:
EEG/EP Laboratory, Massachusetts General Hospital, Boston
*
Reprint requests to: Dr. K.H. Chiappa, EEG/EP Laboratory, Massachusetts General Hospital, Boston, Massachusetts, U.S.A. 02114
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Abstract

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Electroencephalography (EEG) and evoked potential studies are established monitoring tools in the neurological intensive care unit (ICU). These neurophysiologic techniques provide information on physiological state and response to therapy, and may aid diagnosis and prognosis. Serial studies or continuous monitoring may enable changes to be detected prior to irreversible deterioration in the patient's condition. Current computer technology allows simultaneous display and correlation of electrophysiologic parameters, cardiovascular state and intracranial pressure (ICP). Continuous EEG monitoring in the ICU has been shown to have a decisive or contributing impact on medical decision making in more than three-quarters of patients. In addition, continuous EEG monitoring has revealed previously unsuspected non-convulsive seizures in one-third of patients. SEPs and BAEPs can provide useful prognostic information in coma - however, these tests are etiologically nonspecific and must be carefully integrated into the clinical situation. Motor evoked potentials offer a potentially useful tool for evaluating motor system abnormalities in the ICU.

Résumé

Résumé

L'électroencéphalographie et les études de potentiels évoqués sont des methodes de surveillance reconnues à l'unité de soins intensifs neurologiques. Ces techniques neurophysiologiques fournissent de l'information sur l'état physiologique et sur la réponse thérapeutique et peuvent aider à établir le diagnostic et le pronostic. Des études en série ou une surveillance continue peuvent signaler des changements avant qu'une détérioration irréversible de la condition du patient ne survienne. La technologie informatique actuelle permet la visualisation et la corrélation simultanées des paramètres électrophysiologiques, de l'état cardiovasculaire et de la pression intracrânienne. Il a été démontré que le monitoring continu de l'EEG à l'unité de soins intensifs a un impact décisif ou tout au moins contribue au processus de décision médicale chez plus des trois-quarts des patients. De plus, le monitoring EEG continu a révélé des crises non convulsives qu'on n'avait pas soupçonnées antérieurement chez un tiers des patients. Les pontentiels évoqués sensitifs et auditifs peuvent fournir une information pronostique utile chez les patients comateux. Cependant, ces épreuves ne sont pas spécifiques quant a la cause et doivent etre intégrées avec prudence à la clinique. Les potentiels évoqués moteurs sont un outil qui peut s'avérer utile dans l'évaluation des anomalies du système moteùr à l'unité de soins intensifs.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 21 , Issue S1: Neurocritical Care Symposium , February 1994 , pp. S12 - S16
Copyright
Copyright © The Canadian Journal of Neurological 1994

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