Abstract
IntroductionSeveral studies have reported the presence of electroencephalography (EEG) abnormalities or altered evoked potentials (EPs) during sepsis. However, the role of these tests in the diagnosis and prognostic assessment of sepsis-associated encephalopathy remains unclear.MethodsWe performed a systematic search for studies evaluating EEG and/or EPs in adult (≥18 years) patients with sepsis-associated encephalopathy. The following outcomes were extracted: a) incidence of EEG/EP abnormalities; b) diagnosis of sepsis-associated delirium or encephalopathy with EEG/EP; c) outcome.ResultsAmong 1976 citations, 17 articles met the inclusion criteria. The incidence of EEG abnormalities during sepsis ranged from 12% to 100% for background abnormality and 6% to 12% for presence of triphasic waves. Two studies found that epileptiform discharges and electrographic seizures were more common in critically ill patients with than without sepsis. In one study, EEG background abnormalities were related to the presence and the severity of encephalopathy. Background slowing or suppression and the presence of triphasic waves were also associated with higher mortality. A few studies demonstrated that quantitative EEG analysis and EP could show significant differences in patients with sepsis compared to controls but their association with encephalopathy and outcome was not evaluated.ConclusionsAbnormalities in EEG and EPs are present in the majority of septic patients. There is some evidence to support EEG use in the detection and prognostication of sepsis-associated encephalopathy, but further clinical investigation is needed to confirm this suggestion.
Highlights
Several studies have reported the presence of electroencephalography (EEG) abnormalities or altered evoked potentials (EPs) during sepsis
Data collection A systematic review was conducted including articles published from 1 January 1966 to 31 December 2013 in the PubMed database, using the terms ? infection? OR ? inflammation? OR ? sepsis? OR ? septic shock? OR ? severe sepsis? OR ? delirium? OR ? encephalopathy? with: ? electroencephalography? OR ? electroencephalogram? OR ? encephalopathy has been associated with worseElectroencephalography (EEG) monitoring? OR ? EEG? OR ? evoked potential.? The reference lists of review articles were checked for relevant studies
One author (KH) reviewed the full-text articles to select eligible studies according to the PICO approach: 1) patient population, that is, patients suffering from systemic infection, sepsis; 2) intervention provided, that is, monitoring of EEG or EPs; 3) controls, that is, patients with infection or sepsis without sepsis-associated encephalopathy (SAE)/sepsis-associated brain dysfunction (SABD), or healthy individuals; 4) outcome endpoints, that is, incidence of EEG/EP abnormalities, diagnosis of SAE/SABD, ICU/ hospital outcome
Summary
Several studies have reported the presence of electroencephalography (EEG) abnormalities or altered evoked potentials (EPs) during sepsis. The pathophysiology of SAE/SABD is multifactorial and presumably related to the effects of systemic inflammation on cerebral perfusion and neuronal activity, in the absence of direct infection of the central nervous system (CNS) [7,8] Increased severity of this encephalopathy has been associated with worse. A high incidence of background abnormalities was found in another study on septic patients, the authors did not find any association between EEG findings and the presence of SAE [20]. Pattern was associated with the presence of acute ischemic injury on brain imaging; the association with the severity of SAE and outcome was not assessed None of these studies used continuous EEG monitoring so that the persistence of these EEG abnormalities, especially through the nycthemeral cycle, and the presence of normal EEG transients of sleep, were not assessed
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