Division of Neurology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan, U.S.A.
Wayne State University School of Medicine, Detroit, Michigan, U.S.A.
J Clin Neurophysiol. 2019 May;36(3):181-185. doi: 10.1097/WNP.0000000000000566.
The Critical Care Continuous EEG Task Force of the American Clinical Neurophysiology Society recommends continuous EEG (cEEG) monitoring in patients with persistent encephalopathy following convulsive status epilepticus. This recommendation is based on data, which correlates prolonged nonconvulsive seizures and nonconvulsive status epilepticus with worse neurologic outcomes. Compliance with these recommendations may be limited by barriers such as inadequate resource and staff availability. We surveyed members of the Child Neurology Society to determine the barriers that prevent them from appropriately using cEEG, and how they have successfully overcome such obstacles.
A survey was electronically distributed to Child Neurology Society members, which assessed demographics, current clinical practices, and cEEG utilization in critically ill children, with an emphasis on resource availability and strategies to overcome resource limitations.
One hundred forty-six physicians from Child Neurology Society completed the survey. Fifty-three (39.8%) respondents use cEEG to detect nonconvulsive seizures/nonconvulsive status epilepticus in most (>90%) of their pediatric patients who present with persistent encephalopathy following convulsive status epilepticus. Forty-four respondents (34.4%) perceive barriers to performing cEEG monitoring, and 107 (84.9%) of the respondents are implementing changes to overcome barriers. The two most commonly reported barriers included inadequate availability of technicians and EEG machines. The most common changes included hiring new EEG technologists and purchasing new machines. Other barriers included identification of appropriate patients and availability of remote EEG monitoring capabilities.
Barriers, such as resource limitations, prevent compliance with the American Clinical Neurophysiology Society cEEG monitoring recommendations. Recognizing common limitations and learning from each other about successful strategies to overcome these barriers may improve care.
美国临床神经生理学会的重症监护连续脑电图工作组建议对癫痫持续状态后持续性脑病的患者进行连续脑电图（cEEG）监测。这一建议是基于数据得出的，即长时间的非惊厥性发作和非惊厥性癫痫持续状态与更差的神经结局相关。由于资源和人员配备不足等障碍，可能会限制对这些建议的遵守。我们对儿童神经病学学会的成员进行了调查，以确定阻止他们适当使用 cEEG 的障碍，以及他们是如何成功克服这些障碍的。
一项调查以电子方式分发给儿童神经病学学会的成员，评估人口统计学、当前的临床实践以及危重儿童的 cEEG 使用情况，重点是资源的可用性和克服资源限制的策略。
来自儿童神经病学学会的 146 名医生完成了这项调查。53 名（39.8%）受访者在大多数（>90%）癫痫持续状态后出现持续性脑病的儿科患者中使用 cEEG 来检测非惊厥性发作/非惊厥性癫痫持续状态。44 名受访者（34.4%）认为存在进行 cEEG 监测的障碍，107 名（84.9%）受访者正在采取措施克服障碍。报告的两个最常见障碍包括技术人员和脑电图仪的可用性不足。最常见的变化包括雇用新的脑电图技术员和购买新机器。其他障碍包括识别合适的患者和远程脑电图监测能力的可用性。
资源限制等障碍阻碍了对美国临床神经生理学会 cEEG 监测建议的遵守。认识到常见的限制，并相互学习克服这些障碍的成功策略，可能会改善护理。
