When I first started in neurocritical care several years ago, I heard Stephan Mayer give a talk on neuromonitoring in the ICU at a conference where he talked about how continuous EEG should be as ubiquitous in the NSICU as continuous ECG monitoring is in the CCU. It made a lot of sense. After all, we don’t manage arrhythmias by looking once and then not again. We don’t assume that because the patient isn’t in a-fib at that exact moment that they won’t be in a-fib at some point (umm…Holter monitors?). But, that’s pretty much what we do with EEG.
At the time, we hardly had any continuous EEG monitoring in our NSICU. Mayer was at Columbia at the time and he proudly proclaimed that their NSICU had the capability to do continuous EEG as part of the bedside monitor package. A few years later, we still don’t have that sort of setup, but we do have a lot of more continuous EEG monitoring. The problem isn’t actually lack of neurologists (although there is a serious lack of neurologists, especially in smaller areas) but a shortage of the technologists and equipment.
In this episode of the CODA Change Critical Care Podcast, Terry O’Brien, a neurologist from Australia makes the case for greater use of continuous EEG use in the ICU and discusses briefly where he thinks this sort of thing is headed. He makes the comparison with echocardiography. A few years ago, it took an echosonographer or cardiologist to get an echo in the ICU. And, while those formal studies are still available and helpful, plenty of us do bedside echos every day in the ICU and are able to get the information that we need. I think that it’s only a matter of time before the ICU nurses are trained to apply EEG electrodes (at least some basic sort of setup) and intensivists are trained to read them (again, in some sort of basic way).
In this way, its comparable to 12-lead ECGs. Any intensivist worth their salt can read a 12-lead ECG. Now, a cardiologist, and especially an electrophysiologist, can obviously get much more information from that ECG than I can. And I think that’s where EEGs are headed. The average intensivist will be able to read an EEG for seizures and maybe some other basics, while an epileptologist can glean much more and could be formally consulted for more info. Speaking of reading EEGs, I’m working on a post about that, so if that interests you, stay tuned.
In the meantime, listen to Terry O’Brien’s talk on continuous EEG in the ICU here.
critical care notes 