Association of Periodic Discharges With Reduced Brain Tissue Oxygenation: No Longer Straddling the Fence?

One of the diagnostic tools used with increasing frequency in intensive care units (ICUs) is continuous electroencephalography (cEEG) monitoring. In the United States, such monitoring was noted to increase by more than 260% in only 4 years from 2005 to 2009.¹ The increasing use of cEEG monitoring has potentially been associated with improvements in the morbidity and mortality of critically ill patients. In a retrospective cross-sectional study of the Nationwide Inpatient Sample,¹ the largest all-payer data set of inpatient hospitalizations in the United States, cEEG monitoring was significantly associated with lower in-hospital mortality. Such reductions may be secondary to the increasing detection and treatment of clearly ictal EEG patterns. Electrographic seizures have previously been reported in almost 20% of hospitalized patients undergoing monitoring with cEEG.² More than 90% of such seizures were nonconvulsive, suggesting they potentially would have been missed and not treated had cEEG not been performed.²