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Processed Electroencephalogram-Based Monitoring to Guide Sedation in Critically Ill Adult Patients: Recommendations
Frank A Rasulo1,2, Philip Hopkins3, Francisco A Lobo4
1Department of Anesthesiology and Intensive Care, Spedali Civili Hospital, Brescia, Italy. francesco.rasulo@unibs.it.
Neurocritical Care
|July 27, 2022
Summary
Processed electroencephalography (pEEG) is adequate for monitoring depth of sedation (DOS) in intensive care units (ICUs). Sedated patients unfit for clinical evaluation benefit from DOS monitoring with pEEG after staff training.
Area of Science:
- Critical Care Medicine
- Neuroscience
- Anesthesiology
Background:
- Processed electroencephalography (pEEG) use for depth of sedation (DOS) monitoring is growing in anesthesia.
- Application of pEEG for DOS monitoring in adult intensive care unit (ICU) patients remains unclear.
Purpose of the Study:
- To establish consensus among international experts on the use of pEEG for DOS monitoring in ICU patients.
- To address knowledge gaps and guide the routine application of pEEG in critical care settings.
Main Methods:
- A multidisciplinary panel of 21 international experts in neurocritical care and neuroanesthesiology was convened.
- A Delphi method with iterative feedback was used to develop consensus statements on pEEG monitoring in ICUs.
- Statements were rated for appropriateness and disagreement to achieve consensus.
Main Results:
- Frontal pEEG with continuous colored density spectrograms is considered adequate for DOS monitoring (strong consensus).
- The panel recommends DOS monitoring with pEEG for all sedated ICU patients (paralyzed or nonparalyzed) unfit for clinical evaluation, post-training.
- Barriers to routine application include lack of knowledge, validation for prolonged sedation, monitor standardization, and economic factors.
Conclusions:
- Evidence for DOS monitors in ICUs is limited, necessitating further research.
- Critically ill patients may benefit from pEEG neuromonitoring.
- Consensus provides guidance for pEEG implementation in ICUs.
