EEG monitoring in the intensive care unit: pitfalls and caveats

Electroencephalogram monitoring is a valuable means of monitoring thalamocortical function in the comatose, sedated, or paralyzed patient in the intensive care unit. The following problems arise especially with long-term recordings that are beyond those experienced in the standard EEG laboratory: 1) faulty electrodes, either single- or multiple-scalp electrodes or ground or reference electrodes; 2) connections of electronic equipment; 3) induced artifacts from electronic devices and nonelectronic equipment; 4) electrode placement issues; and 5) biologic, including movement-related, artifacts. Continuous quality improvement strategies should be implemented to minimize problems. Prompt troubleshooting and regular review sessions are two important components.