Waak Michaela, Laing Joshua, Nagarajan Lakshmi, Lawn Nicholas, Harvey A Simon
Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Australia.
Paediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Australia.
Crit Care Resusc. 2023 May 23;25(1):9-19. doi: 10.1016/j.ccrj.2023.04.004. eCollection 2023 Mar.
This article aims to critically review the literature on continuous electroencephalography (cEEG) monitoring in the intensive care unit (ICU) from an Australian and New Zealand perspective and provide recommendations for clinicians.
A taskforce of adult and paediatric neurologists, selected by the Epilepsy Society of Australia, reviewed the literature on cEEG for seizure detection in critically ill neonates, children, and adults in the ICU. The literature on routine EEG and cEEG for other indications was not reviewed. Following an evaluation of the evidence and discussion of controversial issues, consensus was reached, and a document that highlighted important clinical, practical, and economic considerations regarding cEEG in Australia and New Zealand was drafted.
This review represents a summary of the literature and consensus opinion regarding the use of cEEG in the ICU for detection of seizures, highlighting gaps in evidence, practical problems with implementation, funding shortfalls, and areas for future research.
While cEEG detects electrographic seizures in a significant proportion of at-risk neonates, children, and adults in the ICU, conferring poorer neurological outcomes and guiding treatment in many settings, the health economic benefits of treating such seizures remain to be proven. Presently, cEEG in Australian and New Zealand ICUs is a largely unfunded clinical resource that is subsequently reserved for the highest-impact patient groups. Wider adoption of cEEG requires further research into impact on functional and health economic outcomes, education and training of the neurology and ICU teams involved, and securement of the necessary resources and funding to support the service.
本文旨在从澳大利亚和新西兰的视角，对重症监护病房（ICU）中持续脑电图（cEEG）监测的相关文献进行批判性综述，并为临床医生提供建议。
由澳大利亚癫痫协会挑选的成人及儿科神经科医生组成的特别工作组，对ICU中危重新生儿、儿童和成人癫痫检测的cEEG相关文献进行了综述。未对常规脑电图和cEEG用于其他适应症的文献进行综述。在对证据进行评估并讨论有争议的问题后，达成了共识，并起草了一份强调澳大利亚和新西兰cEEG重要临床、实际和经济考量的文件。
本综述总结了关于在ICU中使用cEEG检测癫痫的文献和共识意见，突出了证据空白、实施中的实际问题、资金短缺以及未来研究领域。
虽然cEEG能在很大比例的ICU高危新生儿、儿童和成人中检测到脑电图癫痫发作，在许多情况下预示着较差的神经学预后并指导治疗，但治疗此类癫痫发作的健康经济效益仍有待证实。目前，澳大利亚和新西兰ICU中的cEEG在很大程度上是一项无资金支持的临床资源，因此仅保留给影响最大的患者群体。更广泛地采用cEEG需要进一步研究其对功能和健康经济结果的影响、对相关神经科和ICU团队的教育与培训，以及确保支持该服务所需的资源和资金。
