EEG for bedside monitoring: the intensivist’s point of view

Electroencephalography (EEG) is a powerful tool that can provide unique and real time insight into cerebral functioning in the context of acute brain injury in the intensive care unit (ICU), ranging from focal deficits to seizures and coma. Despite being a safe, relatively inexpensive, non-invasive and meaningful tool, EEG has not yet transitioned into a true bedside monitoring system in the ICU, as continuous EEG monitoring cannot realistically be provided to all ICU patients, and EEG implementation and interpretation remains heavily dependent on specialized personnel. In order to integrate EEG into routine ICU monitoring, two conditions must be fulfilled: first, the EEG montage should be adjusted to answer the specific clinical question; second, the presentation of EEG-derived information must be stratified and adapted to the healthcare professional interpreting it, from the inexperienced nurses and junior physicians to the experienced neurophysiologist. Integrating the EEG into the multimodal monitoring of critically ill patients would allow earlier detection of reversible brain insults, it would promote brain monitoring across different levels of expertise, and it could potentially expand EEG use with rapid data acquisition that could facilitate early identification and treatment of acute brain events, even outside the ICU.