TY - JOUR
T1 - Processed Electroencephalogram-Based Monitoring to Guide Sedation in Critically Ill Adult Patients
T2 - Recommendations from an International Expert Panel-Based Consensus
AU - Rasulo, Frank A
AU - Hopkins, Philip
AU - Lobo, Francisco A
AU - Pandin, Pierre
AU - Matta, Basil
AU - Carozzi, Carla
AU - Romagnoli, Stefano
AU - Absalom, Anthony
AU - Badenes, Rafael
AU - Bleck, Thomas
AU - Caricato, Anselmo
AU - Claassen, Jan
AU - Denault, André
AU - Honorato, Cristina
AU - Motta, Saba
AU - Meyfroidt, Geert
AU - Radtke, Finn Michael
AU - Ricci, Zaccaria
AU - Robba, Chiara
AU - Taccone, Fabio S
AU - Vespa, Paul
AU - Nardiello, Ida
AU - Lamperti, Massimo
N1 - © 2022. The Author(s).
PY - 2023/4
Y1 - 2023/4
N2 - BACKGROUND: The use of processed electroencephalography (pEEG) for depth of sedation (DOS) monitoring is increasing in anesthesia; however, how to use of this type of monitoring for critical care adult patients within the intensive care unit (ICU) remains unclear.METHODS: A multidisciplinary panel of international experts consisting of 21 clinicians involved in monitoring DOS in ICU patients was carefully selected on the basis of their expertise in neurocritical care and neuroanesthesiology. Panelists were assigned four domains (techniques for electroencephalography [EEG] monitoring, patient selection, use of the EEG monitors, competency, and training the principles of pEEG monitoring) from which a list of questions and statements was created to be addressed. A Delphi method based on iterative approach was used to produce the final statements. Statements were classified as highly appropriate or highly inappropriate (median rating ≥ 8), appropriate (median rating ≥ 7 but < 8), or uncertain (median rating < 7) and with a strong disagreement index (DI) (DI < 0.5) or weak DI (DI ≥ 0.5 but < 1) consensus.RESULTS: According to the statements evaluated by the panel, frontal pEEG (which includes a continuous colored density spectrogram) has been considered adequate to monitor the level of sedation (strong consensus), and it is recommended by the panel that all sedated patients (paralyzed or nonparalyzed) unfit for clinical evaluation would benefit from DOS monitoring (strong consensus) after a specific training program has been performed by the ICU staff. To cover the gap between knowledge/rational and routine application, some barriers must be broken, including lack of knowledge, validation for prolonged sedation, standardization between monitors based on different EEG analysis algorithms, and economic issues.CONCLUSIONS: Evidence on using DOS monitors in ICU is still scarce, and further research is required to better define the benefits of using pEEG. This consensus highlights that some critically ill patients may benefit from this type of neuromonitoring.
AB - BACKGROUND: The use of processed electroencephalography (pEEG) for depth of sedation (DOS) monitoring is increasing in anesthesia; however, how to use of this type of monitoring for critical care adult patients within the intensive care unit (ICU) remains unclear.METHODS: A multidisciplinary panel of international experts consisting of 21 clinicians involved in monitoring DOS in ICU patients was carefully selected on the basis of their expertise in neurocritical care and neuroanesthesiology. Panelists were assigned four domains (techniques for electroencephalography [EEG] monitoring, patient selection, use of the EEG monitors, competency, and training the principles of pEEG monitoring) from which a list of questions and statements was created to be addressed. A Delphi method based on iterative approach was used to produce the final statements. Statements were classified as highly appropriate or highly inappropriate (median rating ≥ 8), appropriate (median rating ≥ 7 but < 8), or uncertain (median rating < 7) and with a strong disagreement index (DI) (DI < 0.5) or weak DI (DI ≥ 0.5 but < 1) consensus.RESULTS: According to the statements evaluated by the panel, frontal pEEG (which includes a continuous colored density spectrogram) has been considered adequate to monitor the level of sedation (strong consensus), and it is recommended by the panel that all sedated patients (paralyzed or nonparalyzed) unfit for clinical evaluation would benefit from DOS monitoring (strong consensus) after a specific training program has been performed by the ICU staff. To cover the gap between knowledge/rational and routine application, some barriers must be broken, including lack of knowledge, validation for prolonged sedation, standardization between monitors based on different EEG analysis algorithms, and economic issues.CONCLUSIONS: Evidence on using DOS monitors in ICU is still scarce, and further research is required to better define the benefits of using pEEG. This consensus highlights that some critically ill patients may benefit from this type of neuromonitoring.
KW - Adult
KW - Anesthesia
KW - Consensus
KW - Critical Care/methods
KW - Critical Illness
KW - Electroencephalography/methods
KW - Humans
U2 - 10.1007/s12028-022-01565-5
DO - 10.1007/s12028-022-01565-5
M3 - Article
C2 - 35896766
SN - 1541-6933
VL - 38
SP - 296
EP - 311
JO - Neurocritical Care
JF - Neurocritical Care
IS - 2
ER -