April 14, 2011
Brain Awareness Month: SickKids improves care for critically ill children
Critically ill children admitted to the intensive care unit (ICU) often have multiple health issues that put them at risk for brain injury, which can have a significant long-term impact on their health. The brain is a vital organ that controls movement, thought and neurological functions which control blood pressure, heart rate, body temperature and organ function.
Although continuous monitoring of the heart and lungs has been part of standard ICU care for many years, continuous brain monitoring has not been routine. Recent advances in digital technology have made it possible to use electroencephalograms (EEGs) as a continuous brain monitoring tool.
Researchers at SickKids are currently studying the use of EEG as a way to continuously monitor the brain of critically ill children in real-time. Neurologist Dr. Cecil Hahn and a team of neurophysiologists, EEG technologists, ICU physicians and nurses have integrated continuous EEG (cEEG) monitoring into the care of these children and are evaluating the benefits of this non-invasive bedside test.
The study has found that among 194 critically ill children monitored with cEEG over a six year period, 50 per cent had seizures and 32 per cent (or 62 patients) had seizures that would have gone undetected without continuous monitoring. A routine 30-minute EEG would have detected only nine per cent of the seizures. “Our findings demonstrate that seizures are quite common among certain critically ill children, and that continuous EEG monitoring provides much more insight than short intermittent EEGs,” says Hahn. Seizures are caused by an abnormal over-activity of the brain, which can place additional stress on the already vulnerable brain of critically ill children.
Children in the ICU are often sedated or in a coma, which makes it difficult for caregivers to tell when a child is having a seizure, particularly nonconvulsive seizures that occur without any outward signs.
“Right now we are only monitoring children with EEG when there is a suspicion of seizures, however other children in coma may also be at risk for seizures,” says Hahn.
In another clinical research study currently underway. Dr. Hahn and colleagues are examining the problem of nonconvulsive seizures among comatose children in the ICU. The study is funded by the SickKids Foundation, the Canadian Institutes of Health Research, and the PSI Foundation. Dr. Hahn hopes to answer questions such as how many children in the ICU are actually experiencing seizures? Which children are at greatest risk for seizures and would most benefit from EEG monitoring? How do these seizures contribute to brain injury, and what is their impact on long-term outcome? These qestions and others will be the focus for Dr. Hahn and his team for the next three years.
“Continuous EEG monitoring is a significant investment on the part of SickKids, both in terms of equipment and personnel,” Dr. Hahn says. “Ultimately, our goal is to harness the technology and the expertise of our multidisciplinary team to prevent brain injury in critically ill children and improve their long-term outcome.”