Department of Neuroanesthesiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Department of Clinical Neurophysiology, The Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Neurocrit Care. 2020 Feb;32(1):121-130. doi: 10.1007/s12028-019-00703-w.
Delirium is common during sepsis, although under-recognized. We aimed to assess the value of continuous electroencephalography (cEEG) to aid in the diagnosis of delirium in septic patients.
We prospectively evaluated 102 consecutive patients in a medical intensive care unit (ICU), who had sepsis or septic shock, without evidence of acute primary central nervous system disease. We initiated cEEG recording immediately after identification. The median cEEG time per patient was 44 h (interquartile range 21-99 h). A total of 6723 h of cEEG recordings were examined. The Confusion Assessment Method for the ICU (CAM-ICU) was administered six times daily to identify delirium. We analyzed the correlation between cEEG and delirium using 1252 two-minute EEG sequences recorded simultaneously with the CAM-ICU scorings.
Of the 102 included patients, 66 (65%) had at least one delirium episode during their ICU stay, 30 (29%) remained delirium-free, and 6 (6%) were not assessable due to deep sedation or coma. The absence of delirium was independently associated with preserved high-frequency beta activity (> 13 Hz) (P < 10) and cEEG reactivity (P < 0.001). Delirium was associated with preponderance of low-frequency cEEG activity and absence of high-frequency cEEG activity. Sporadic periodic cEEG discharges occurred in 15 patients, 13 of whom were delirious. No patient showed clinical or electrographic evidence of non-convulsive status epilepticus.
Our findings indicate that cEEG can help distinguish septic patients with delirium from non-delirious patients.
脓毒症患者常发生谵妄，但易被漏诊。我们旨在评估连续脑电图（cEEG）在帮助诊断脓毒症患者谵妄中的价值。
我们前瞻性评估了 102 例连续收入重症监护病房（ICU）的脓毒症或脓毒性休克患者，这些患者没有急性原发性中枢神经系统疾病的证据。我们在确诊后立即开始进行 cEEG 记录。每位患者的中位 cEEG 时间为 44 小时（四分位距 21-99 小时）。共检查了 6723 小时的 cEEG 记录。采用 ICU 意识模糊评估法（CAM-ICU）每天评估 6 次以识别谵妄。我们分析了 cEEG 与谵妄之间的相关性，使用与 CAM-ICU 评分同时记录的 1252 个两分钟脑电图序列进行分析。
102 例纳入患者中，66 例（65%）在 ICU 期间至少发生一次谵妄发作，30 例（29%）无谵妄发作，6 例（6%）因深度镇静或昏迷而无法评估。无谵妄与高频β活动（>13 Hz）保留（P < 10）和 cEEG 反应性（P < 0.001）独立相关。谵妄与低频 cEEG 活动优势和高频 cEEG 活动缺失相关。15 例患者出现散发性周期性 cEEG 放电，其中 13 例为谵妄患者。无患者出现临床或脑电图证据的非惊厥性癫痫持续状态。
我们的研究结果表明，cEEG 可帮助区分有谵妄的脓毒症患者和无谵妄的患者。
