Electroencephalogram Monitoring in Critically Ill Children: Indications and Strategies

被引:38
|
作者
Gutierrez-Colina, Ana M. [1 ]
Topjian, Alexis A. [2 ]
Dlugos, Dennis J. [1 ,3 ,4 ]
Abend, Nicholas S. [1 ,3 ,4 ]
机构
[1] Childrens Hosp Philadelphia, Dept Pediat, Philadelphia, PA 19104 USA
[2] Childrens Hosp Philadelphia, Dept Anesthesia & Crit Care Med, Philadelphia, PA 19104 USA
[3] Univ Penn, Sch Med, Dept Neurol, Philadelphia, PA 19104 USA
[4] Univ Penn, Sch Med, Dept Pediat, Philadelphia, PA 19104 USA
基金
美国国家卫生研究院;
关键词
INTENSIVE-CARE-UNIT; NONCONVULSIVE STATUS EPILEPTICUS; HYPOTHERMIC CIRCULATORY ARREST; TRAUMATIC BRAIN-INJURY; ELECTROGRAPHIC SEIZURES; NEONATAL SEIZURES; EEG; PREDICTORS;
D O I
10.1016/j.pediatrneurol.2011.12.009
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Continuous electroencephalographic monitoring often detects nonconvulsive seizures in critically ill children, but it is resource-intense and has not been demonstrated to improve outcomes. As institutions develop clinical pathways for monitoring, they should consider how seemingly minor variations may exert substantial impacts on resource utilization and cost. In our 1-month prospective observational study, each patient in a 45-bed pediatric intensive care unit was screened for potential monitoring indications. We screened 247 patients. Minor differences in monitoring indications would exert substantial impact on resource utilization. We then calculated the number of monitoring days required each month, based on two strategies that differed in monitoring duration. The prolonged-targeted and brief-targeted strategies would have required 106 and 33 monitoring days, respectively. Based on nonconvulsive seizure occurrence data, these strategies would detect 0.14, and 0.43 patients with seizures per monitoring day performed, respectively. A brief-targeted strategy provides a high yield for nonconvulsive seizure identification, but would fail to diagnose some patients with seizures. (C) 2012 Elsevier Inc. All rights reserved.
引用
收藏
页码:158 / 161
页数:4
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