40 Questions
What is the minimum voltage required to define an electrographic seizure?
2 µV
What is the term used to describe the evolution in frequency, voltage, morphology, or location of an electrographic seizure?
Evolving pattern
Which of the following is NOT a type of QEEG trend?
Heart rate variability
What is the purpose of EEG testing in the ICU?
To determine whether a patient is suffering from seizures and whether they are focal or generalized
What is the term used to quantify seizure burden for clinical purposes?
All of the above
What is the term used to describe the variability of background alpha activity in a QEEG trend?
Relative alpha variability (RAV)
What is the primary indication for CEEG monitoring?
Seizures, NCS, and NCSE
What is the duration of an electrographic seizure?
At least 10 seconds
What is the significance of QEEG trend changes during vasospasm in patients following SAH?
They have a direct influence on improving patient outcome by recognizing the changes and notifying the interpreting physician
What is the usual pattern associated with impaired cerebral function?
Slowing of the EEG background activity
What type of damage produces continuous focal slowing seen maximally over the damaged area?
Structural damage
What is a favorable prognostic feature in EEG?
Background continuity
What is the purpose of EEG in predicting outcome in neurologic conditions?
To determine the nature of encephalopathy or coma
What is a clinical population in which EEG may aid in prognosis?
All of the above
What is the significance of EEG parameters in predicting outcome?
They have a high false-positive rate
What is the purpose of prolonged monitoring in EEG?
To determine whether prolonged monitoring is superior to briefer EEG recordings
What is the recommended sensitivity setting for at least 30 minutes of the recording?
2 µV/mm
What is the primary consideration when selecting an electrode application method for a patient in the ICU?
The patient's clinical situation
What is the primary focus of neurologic critical care?
Recognition and treatment of secondary insults
What type of electrodes are typically used for cEEG monitoring in the ICU?
Gold disk cup electrodes
What is the primary benefit of continuous EEG monitoring in the ICU?
Identification of seizures and vasospasm following SAH
What is the primary goal of EEG intraoperative monitoring and ICU monitoring?
To intervene in time to avoid neurologic deficits
What is a common source of artifacts in ICU cEEG monitoring?
Equipment and patient care maneuvers
What is the recommended minimum distance between electrode montages?
10 cm
What is the consequence of nonconvulsive seizures and nonconvulsive status epilepticus in comatose patients?
Damaging to brain tissue
What should neurodiagnostic technologists be proficient at recognizing in ICU cEEG monitoring?
Artifacts
What is the recommended number of electrodes to use in ICU-CEEG monitoring?
10-20 electrodes
What is the purpose of this paper?
To examine the use and benefits of EEG monitoring of ICU patients
What is the purpose of documenting the patient's current blood pressure, oxygen saturation, and core body temperature?
To provide a complete picture of the patient's condition
What should be done to eliminate artifacts caused by muscle activity in ICU cEEG monitoring?
Administer neuromuscular junction blockade
What is the primary indication for the use of cEEG in ICU patients?
Assessment of coma and brain death
What is the benefit of early intervention in ICU patients with seizures?
Preservation of brain function
What is the significance of EEG changes in ICU monitoring?
They are a sign of neurologic complications requiring intervention
What is a consideration when selecting electrodes for cEEG monitoring in the ICU?
All of the above
What is the purpose of testing reactivity to intense stimuli in ICU-CEEG monitoring?
To assess the patient's level of consciousness
What is the purpose of setting the LF to 0.3 Hz in Figure 11?
To record delta activity
What is the significance of continuous EEG monitoring in ICU patients?
It provides a unique potential to recognize secondary insults and offers an opportunity for early intervention
What is the primary concern in ICU patients with nonconvulsive seizures and nonconvulsive status epilepticus?
Rapid control of seizures to preserve brain function
What should neurodiagnostic technologists be able to do once an artifact is identified in ICU cEEG monitoring?
All of the above
What is the significance of using electrodes with impedances below 10,000 ohms?
To increase EEG signal quality
Study Notes
ICU-cEEG Monitoring
- The use of EEG as a monitoring tool in the ICU affords many potential benefits, including the identification of seizures, vasospasm following subarachnoid hemorrhage (SAH), and the assessment of coma and brain death.
- Continuous EEG (cEEG) monitoring provides a unique potential to recognize secondary insults and offers an opportunity for early intervention.
Indications for cEEG Monitoring
- Seizures, non-convulsive seizures (NCS), and non-convulsive status epilepticus (NCSE) are damaging to brain tissue, thus rapid control of seizures is essential to preserving brain function.
- EEG monitoring helps guide the choice of medications most effective for the patient's seizures.
- An electrographic seizure is defined by a repetitive and evolving pattern with a minimum 2 µV voltage and duration of at least 10 seconds.
Encephalopathy and Coma
- The EEG contains clues that are helpful in determining the nature of an encephalopathy or coma and provides clues regarding the patient's prognosis or response to therapy.
- Slowing of the EEG background activity is the usual pattern associated with impaired cerebral function.
- Unfavorable prognostic factors include isoelectric pattern, burst suppression pattern, periodic patterns, and electrographic seizures.
- Favorable prognostic features include background continuity, spontaneous variability, reactivity to stimulation, and presence of normal sleep patterns.
ICU-CEEG Monitoring Techniques
- Recommendations for EEG recordings include using a complete complement of 10-20 electrodes, montages of electrodes at least 10 cm apart, increasing the sensitivity to 2 µV/mm, and using appropriate filter settings.
- Documenting all medications the patient is currently taking, as well as the patient's current blood pressure, oxygen saturation, and core body temperature is essential.
Technical and Safety Protocols
- The Neurodiagnostic technologist should select the electrode application method that is most appropriate to the patient's clinical situation.
- Critical care monitoring programs should consider the electrode cost, ease of use, time for application, imaging compatibility, durability, and recording characteristics when selecting electrodes.
- Neurodiagnostic technologists who perform cEEG in the ICU should be extensively trained and credentialed, and proficient at recognizing and eliminating artifacts.
Learn about the benefits and indications of using continuous EEG (cEEG) monitoring in Intensive Care Units (ICUs), including seizure identification and coma assessment.
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