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Chapter 9 Continuous ICU EEG monitoring

2000; Elsevier BV; Linguagem: Inglês

10.1016/s1567-424x(09)70140-0

1567-424X

Marc R. Nuwer, Kenneth G. Jordan,

Intraoperative Neuromonitoring and Anesthetic Effects

Electroencephalography (EEG) is tightly linked to cerebral metabolism. A significant adverse or favorable change in metabolism is often reflected in EEG changes. It is sensitive to the most common causes of secondary cerebral injury in the intensive care unit (ICU): ischemia and hypoxia. Continuous ICU EEG monitoring extends the clinicians powers of observation to detect serious nervous system impairment while there still is time to reverse the process, Clinicians in the ICU have long used methods of monitoring other organ systems. Continuous ICU EEG monitoring draws certain lessons from continuous operating room monitoring of EEG and evoked potentials. From carotid endarterectomy monitoring, the relationships between EEG changes and the brain's tolerance for partial temporary ischemia are known. Lessons from long-term EEG monitoring for epilepsy include technical details of carrying out monitoring for many days. Several approaches to monitoring EEG in the ICU are in use. This chapter discusses two models are discussed here. In the St. Bemardine's model, nurses are taught to read the fundamental aspects of the EEG. Nurses serve as the front line caregiver and make the ideal professional to understand and respond to EEG changes. Several specific aspects of the EEG are evaluated continuously and charted repeatedly, including the asymmetry and the general frequency content. EEG monitoring in neuro-ICU patients reduces the length of ICU stay, the length of hospital stay and the cost of care. As such, monitoring is a cost-effective tool as well as a quality-enhancing tool.