Continuous EEG monitoring in children in the intensive care unit (ICU)

Pediatric EEG in the intensive care unit (ICU) requires specific technical requirements in order to yield relevant data depending upon clinical scenario: diagnosis of electroclinical or subclinical seizures, their quantification before and after therapeutic changes and sometimes evaluation of severity of cortical dysfunction. The urgent nature of these indications implies the rapid set-up of the EEG system by qualified staff and possibility of maintaining the electrodes in place during long periods of time. Various techniques are available today for EEG monitoring, the interpretation of which depends on the contribution of an experienced physician. Among recent techniques, those most commonly used are trend curves obtained via signal analysis such as amplitude EEG (a-EEG) and density spectral array (DSA) or compressed spectral array (CSA). Trend curves enable the digital creation of a display graph containing several hours of transformed and compressed EEG recorded data. Visualized on one sole display graph, these trend curves can facilitate the identification of very slow changes in EEG background activity and their variation (alertness cycles, changes linked to treatment administrations) as well as seizure patterns and their quantification. In this chapter, we propose a brief overview of monitoring techniques, followed by a review of the various data yielded by EEG monitoring as well as the relevance of this type of management; finally, detailed clinical indications will be discussed after thorough analysis of the literature.