Paul Garcia - April 15, 2020

Paul S. Garcia, MD, PhD, "Frontal electroencephalographic features to aid in sedation for mechanical ventilation during coronavirus pandemic"

One prominent feature common to patients admitted for intensive care related to SARS-CoV-2 infection is the large sedation requirements necessary for synchronization with mechanical ventilation. Due to the coronavirus pandemic, hospitals face critical shortages of many supplies including medications. Our case series with 14 patients focused on the use of frontal EEG monitors for titration of sedative medications. Evaluation of raw EEG traces revealed that cerebral dysfunction could be present in a large proportion of critically ill COVID-19 patients. In patients who were concurrently receiving neuromuscular blockade to aid in pulmonary support, it was possible to decrease hypnotic medications without any frontal EEG signals indicative of cortical arousal. Sedation titration in patients not receiving neuromuscular blockade was still possible but must be considered in the context of other clinical goals, specifically ventilation weaning. One patient was monitored with both an abbreviated (frontal EEG only) and a full electrode montage (international 10-20 system) which revealed no specific focal lesion but rather a generalized cerebral dysfunction. Neurologic manifestations, including encephalopathy can delay extubation and increase the length of ICU stay. The convenience of an abbreviated montage of adhesive EEG electrodes applied at point-of-care for sedation titration during mechanical ventilation preserves resources and may shorten the number of ventilated days in the ICU.

Summary provided by presenter.