Continuous EEG monitoring in the PICU.

Since the first human electroencephalogram (EEG) was recorded in 1929 by Hans Berger, enormous advances have been made in EEG recording technology and data analysis [1, 2]. The recording period was extended and long-term EEG monitoring became technically feasible when computer applications were introduced in the 1970s and digital EEG recording systems established. However, the use of long-term EEG monitoring was mostly limited to epilepsy monitoring units and only subsequently found its way to the intensive care unit (ICU). Yet, an old comparison to cardiology still holds true: While it is an unchallenged standard to continuously monitor heart function in all ICU patients with abnormal cardiac function, brain activity is often not monitored in patients with acute brain damage, mainly because brain function has been more difficult to monitor. A single or even repeated EEG represents only a small sample of data. For example, seizures in the ICU setting are usually brief and paroxysmal and can easily be missed when EEG recording is performed intermittently. Fortunately, over the past 15 years, rapid advances in computer technology and digital data transmission and analysis have made it possible to introduce continuous EEG monitoring in the ICU. The goal of continuous EEG monitoring is to enable intensive care physicians to predict impending central nervous system (CNS) injury at a time when intervention is still possible. The challenge for the future will be to demonstrate that intensified monitoring of brain function by continuous EEG will result in better outcomes.