Changes in clinical management related to continuous versus routine EEG in critically ill adults: analysis of a...

Continuous electroencephalogram (cEEG) is increasingly utilized in the intensive care unit for consciousness-impaired patients with various conditions. It is, however, costly in terms of technical and human resources, and its impact on prognosis compared with routine EEG (rEEG) remains debated. We aimed to characterize the effect of cEEG vs rEEG on clinical management modifications, and to determine if these correlated with a better outcome.

This is an ancillary analysis using data of CERTA (NCT03129438), a randomized trial comparing cEEG versus repeated rEEG in critically ill adults with altered consciousness. Clinical management modifications due to the EEG intervention, pre-defined as performed within 60 hours of EEG start, were prospectively recorded (anti-seizure medication -ASM, sedation, new radiological examination, new surgical intervention, withdrawal of life sustaining therapy). Correlation with the EEG type were analyzed by 2x2 tables; Mantel-Haenszel tests explored the impact on mortality and functional outcome at 6 months.

The trial included 364 patients completing follow-up (182 each in the cEEG and rEEG groups). While 58.2% of cEEG and 45.6% of rEEG patients had any management change (p= 0.018), ASM were modified in 22.0% (cEEG) and 12.1% (rEEG) (p = 0.012)); other clinical interventions were comparable across EEG groups. Adjusting for ASM modifications, mortality (p=0.845) and functional outcome (p=0.619) remained similar between the EEG groups.

In critically ill adults, cEEG is associated with more clinical management modifications compared to repeated rEEG, particularly regarding ASM, but this does not seem to translate into improved patients' outcomes.