Continuous electroencephalographic monitoring in critically ill patients: Indications, limitations, and strategies

Research output: Contribution to journalReview articlepeer-review


Objective: Continuous electroencephalography as a bedside monitor of cerebral activity has been used in a range of critically ill patients. This review compiles the indications, limitations, and strategies for continuous electroencephalography in the ICU. Data Source: The authors searched the electronic Medline database. Study Selection and Data Extraction: References from articles of special interest were selected. Data Synthesis and Conclusion: Electroencephalographically-defined suppression is routinely used as the basis for titration of pharmacologic therapy in refractory status epilepticus and intracranial hypertension. The increasing use of continuous electroencephalography reveals a clinically underappreciated burden of epileptiform and epileptic activity in patients with primary acute neurologic disorders, and also in critically ill patients with acquired encephalopathy. Status epilepticus is reported with continuous electroencephalography in 1% to 10% of patients with ischemic stroke, 8% to 14% with traumatic brain injury, 10% to 14% with subarachnoid hemorrhage, 1% to 21% with intracerebral hemorrhage, and 30% of patients following cardiorespiratory arrest. These figures underscore the importance of continuous electroencephalography in the critically ill. The interpretation of continuous electroencephalography in the ICU is challenged by electroencephalography artifacts and the frequent subtle differences between ictal and interictal patterns.

Original languageEnglish (US)
Pages (from-to)1124-1132
Number of pages9
JournalCritical care medicine
Issue number4
StatePublished - Apr 1 2013


  • continuous electroencephalographic monitoring
  • encephalopathy
  • neurocritical care
  • seizures
  • status epilepticus

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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