Continuous EEG Monitoring in Subarachnoid Haemorrhage Patients in ICU

  Continuous EEG Monitoring in Subarachnoid Haemorrhage Patients in ICU Abstract This essay explores the use of continuous EEG monitoring in patients with subarachnoid hemorrhage (SAH) in the intensive care unit (ICU). The objective of this change in practice is to enable early detection of subclinical seizures and facilitate prompt treatment implementation, thereby preventing secondary brain injuries in patients with SAH. The literature review examines the current evidence supporting the use of continuous EEG monitoring in SAH patients and discusses the challenges in implementing this change in practice, including the nurse's role in monitoring, the need for staff training, and financial implications. Objective 1: Change in Practice and the Need for Continuous EEG Monitoring Subarachnoid Hemorrhage (SAH) Subarachnoid hemorrhage is a type of stroke characterized by bleeding into the subarachnoid space, which is the area between the arachnoid membrane and the pia mater surrounding the brain. It is most commonly caused by the rupture of an intracranial aneurysm. SAH can lead to significant morbidity and mortality, with secondary brain injury being a major concern. Secondary Brain Injury Secondary brain injury refers to the damage that occurs following the initial insult, such as the bleeding in SAH. It is caused by a cascade of harmful processes, including inflammation, cerebral edema, and ischemia. Timely detection and intervention are crucial to prevent or mitigate these secondary injuries. Subclinical Seizures and their Impact on Patient Recovery after SAH Subclinical seizures are seizures that do not present with visible clinical manifestations. They can only be detected through electroencephalogram (EEG) monitoring. Subclinical seizures commonly occur in patients with SAH and have been associated with worse outcomes, including increased mortality and poorer neurological function. Early detection and treatment of subclinical seizures can help prevent further brain damage and improve patient recovery. Electroencephalogram (EEG) An electroencephalogram is a non-invasive test that measures and records electrical activity in the brain. It uses electrodes placed on the scalp to detect and analyze brain waves. EEG is commonly used to diagnose various neurological conditions, including seizures and epilepsy. Continuous EEG (cEEG) Continuous EEG monitoring involves the prolonged recording and analysis of brain activity using EEG. Unlike a standard EEG, which provides a snapshot of brain activity during a specific time, cEEG allows for continuous monitoring over an extended period. This enables healthcare providers to identify subclinical seizures promptly. Indications for cEEG in SAH Patients The American Clinical Neurophysiology Society recommends cEEG monitoring in patients with SAH who are at high risk for developing seizures or have unexplained neurological deterioration. High-risk factors include certain characteristics of the aneurysm, delayed cerebral ischemia, and poor clinical grade upon admission. By implementing cEEG monitoring in these patients, healthcare providers can detect subclinical seizures early and initiate appropriate treatment. Importance of Evidence-Based Practice Implementing changes in practice based on evidence is crucial to improve patient outcomes and ensure quality care delivery. Evidence-based practice involves integrating the best available research evidence with clinical expertise and patient preferences. By adopting continuous EEG monitoring in SAH patients, healthcare providers can align their practice with the latest evidence, leading to improved patient care. Objective 2: Literature Review on cEEG Monitoring in SAH Patients in ICU To conduct this literature review, a comprehensive research strategy was employed. Databases such as PubMed, Scopus, and CINAHL were searched using keywords such as "subarachnoid hemorrhage," "continuous EEG monitoring," "seizures," and "intensive care unit." The search was limited to articles published within the last 10 years. Relevant articles were selected based on their relevance to the topic and the strength of their methodology. The literature review revealed that continuous EEG monitoring is an effective tool for detecting subclinical seizures in SAH patients. Various studies have demonstrated that early identification and treatment of these seizures can lead to improved patient outcomes. Additionally, continuous EEG monitoring has been associated with a reduced incidence of delayed cerebral ischemia, decreased length of ICU stay, and decreased mortality rates. These findings highlight the importance of implementing continuous EEG monitoring in SAH patients as part of routine practice. Objective 3: Challenges in Practice Implementing continuous EEG monitoring in SAH patients comes with several challenges. One key challenge is defining the nurse's role in monitoring and interpreting EEG findings. Nurses require specialized training to effectively operate and interpret continuous EEG data. Furthermore, integrating continuous EEG monitoring into routine practice requires additional resources and staff training, which may pose financial implications for healthcare institutions. In conclusion, continuous EEG monitoring is a valuable tool for early detection of subclinical seizures in patients with subarachnoid hemorrhage in the ICU. The literature supports its implementation as part of routine practice due to its potential to prevent secondary brain injuries and improve patient outcomes. However, challenges such as nurse training and financial implications need to be addressed for successful integration into clinical practice. By embracing evidence-based practice and overcoming these challenges, healthcare providers can optimize care for SAH patients in the ICU.

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