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EEG-based Guideline for Delayed Cerebral Ischemia
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A recent paper, published in the Journal of Clinical Neurophysiology and championed by researchers at the Massachusetts General Hospital, presents the process of developing and implementing institutional EEG monitoring-based guidelines for the early detection of Delayed Cerebral Ischemia.
Dr. Eric Rosenthal points out that “after surviving the rupture of an aneurysm, patients with subarachnoid hemorrhage have a high risk of subsequent neurologic worsening, but our major monitoring methods focus on blood vessels not neurons. We sought to implement a method for monitoring “neurons-at-risk” in “patients-at-risk” integrating a variety of EEG methods previously reported in the literature.”
Over a period of more than 2 years, the team showed that capturing neurologic decline was feasible; nearly all events of neurologic decline occurred during the period of monitoring, recommended as 10 days but customized by clinicians based on patient condition (mean of 7 days). According to Dr. Carlos Muñiz, first author in the paper, “the key to our quality improvement process was a rigorous process for developing the guideline led in partnership with our NeuroICU nurse director, clinical nurse specialist, and vascular neurosurgeon (T. Tehan, M. Guanci, A. Patel, respectively), as well as follow-up on every case as a rigorous check on outcomes.”
Along with a battery of pre-specified EEG reporting measures, the guideline details the additional use of invasive multimodal monitoring as part of clinical care for subarachnoid hemorrhage patients with high clinical grade, highlighting the importance of a complete picture in order to better detect neurologic decline before it is irreversible.
Muñiz CF, Shenoy AV, O'Connor KL, et al. Clinical Development and Implementation of an Institutional Guideline for Prospective EEG Monitoring and Reporting of Delayed Cerebral Ischemia. J Clin Neurophysiol. 2016;33(3):217-226. http://www.ncbi.nlm.nih.gov/pubmed/27258445
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Our first webinar of the year will be an overview of a high-interest topic in
neurocritical care.
- Basic science of how spreading depolarizations mediate infarct development
- How to collect recordings in patients
- Clinical importance of spreading depolarization monitoring
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February 7, 2017, is the last day to resigster for this year's COSBID meeting.
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What: American Clinical Neurophysiology Society Annual Meeting & Courses
Where: Sheraton Grand Phoenix, Phoenix, AZ
When: February 8 - 12, 2017
The ACNS Annual Meeting & Courses are designed to provide a solid review of the fundamentals and the latest scientific advances in both “central” and “peripheral” clinical neurophysiology. Presentations at the Annual Meeting & Courses are given by leading experts in the field and have value for healthcare professionals who utilize clinical neurophysiology.
Contact Us: [email protected]
During ACNS, stop by booth #104 to see a demonstration of the Moberg CNS Monitor, which provides cEEG and integrated multimodal monitoring.
See you at the meeting!
For meeting information, please visit: ACNS Annual Meeting and Courses
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From Moberg ICU Solutions
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COSBID
Mar. 29-31, 2017: Berlin
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Publications of Interest
- Muñiz CF, Shenoy AV, O'Connor KL, et al. Clinical Development and Implementation of an Institutional Guideline for Prospective EEG Monitoring and Reporting of Delayed Cerebral Ischemia. J Clin Neurophysiol. 2016;33(3):217-226. http://www.ncbi.nlm.nih.gov/pubmed/27258445
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Wickering E, Gaspard N, Zafar S, et al. Automation of Classical QEEG Trending Methods for Early Detection of Delayed Cerebral Ischemia: More Work to Do. J Clin Neurophysiol. 2016;33(3):227-234. http://www.ncbi.nlm.nih.gov/pubmed/27258446
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Westhall E, Rossetti AO, van Rootselaar AF, et al. Standardized EEG interpretation accurately predicts prognosis after cardiac arrest. Neurology. 2016;86(16):1482-1490. http://www.ncbi.nlm.nih.gov/pubmed/26865516
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Tatum WO, Olga S, Ochoa JG, et al. American Clinical Neurophysiology Society Guideline 7: Guidelines for EEG Reporting. J Clin Neurophysiol. 2016;33(4):328-332. https://www.ncbi.nlm.nih.gov/pubmed/27482790
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Swisher CB, Sinha SR. Utilization of Quantitative EEG Trends for Critical Care Continuous EEG Monitoring: A Survey of Neurophysiologists. J Clin Neurophysiol. 2016;33(6):538-544. https://www.ncbi.nlm.nih.gov/pubmed/27922904
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Koren JP, Herta J, Pirker S, et al. Rhythmic and periodic EEG patterns of 'ictal-interictal uncertainty' in critically ill neurological patients. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2016;127(2):1176-1181. http://www.ncbi.nlm.nih.gov/pubmed/26679421
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Hermans MC, Westover MB, van Putten MJ, Hirsch LJ, Gaspard N. Quantification of EEG reactivity in comatose patients. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology. 2016;127(1):571-580. http://www.ncbi.nlm.nih.gov/pubmed/26183757
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Haider HA, Esteller R, Hahn CD, et al. Sensitivity of quantitative EEG for seizure identification in the intensive care unit. Neurology. 2016. http://www.ncbi.nlm.nih.gov/pubmed/27466474
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This book is designed to meet the need for a practically oriented textbook on the rapidly growing field of continuous EEG (cEEG) monitoring.
- Explains the use and interpretation of continuous EEG (cEEG) monitoring in critically ill patients
- Examines the value of cEEG monitoring in various special situations
- Covers practical topics such as billing, staffing issues, comparison of EEG machines, and training requirements for technologists and physicians
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- Broad but practical reference covering all aspects of ICU EEG monitoring
- Thorough discussion of the indications for ICU EEG monitoring and prevalence of seizures in patient subgroups
- Focus on the challenges of EEG interpretation that are unique to EEG monitoring in the ICU
- Pearls and take-home points highlighted in every chapter
- Includes hard-to-find information on technical aspects, indications, billing and coding, and other administrative and procedural concerns
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