Monitoraggio neurofisiologico continuo EEG-PES in Terapia Intensiva

BACKGROUND. To monitor acute brain injury in NICU we used EEG combined with Somatosensory Evoked Potentials (SEPs) to overcome the disadvantages connected to each technique and to achieve more accuracy in detecting brain function deterioration. METHODS AND RESULTS. 90 patients (traumatic and hemorrhagic; GCS <9) were monitored with continuous EEG-SEP and ICP (Intracranial Pressure). 75 were considered "stable" or improving, considering GCS and CT-scan: in this group SEPs didn 't show significant changes. 15 patients registered neurological deteriorations and SEPs always displayed significant modifications (i.e. amplitude decrease > 50%). SEP and ICP temporal correlation was various: in 40% of them SEP deterioration anticipated ICP increase, 40% was contemporary and in 20% followed. Considering SEP and ICP in relation to short-term outcome, all patients except one with ICP <20 mmHg were stable, whereas 3 patients with ICP > 40 mmHg died. Among 46 patients with ICP 20-40 mmHg, 35 were stable, while 11 showed clinical and neurophysiology deterioration. CONCLUSIONS. We observed that in a range of values (20-40mm Hg) were ICP is scarcely indicative of clinical deterioration, whereas SEP changes can identify it. It is not only important to understand in which percentage SEP changes come before the ICP increase, but also that SEPs are a complementary support for the ICP interpretation and management. About 60% of our patients were deeply sedated and only SEP insensitivity to anaesthetics allowed following brain damage evolution when EEG was scarcely valuable. We had 3% of non convulsive status epilepticus compared to 19% of neurological deterioration. If the aim of the neurophysiologic monitoring is to "detect and protect", then it can I be limited to seizures detection, but it should also be able to identify brain deterioration. To the end we propose to combine the EEG with the SEPs monitoring.