Abstract Details

Title EEG Signatures of Delirium and Coma in Mechanically Ventilated ICU Patients

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P16 - Poster Session 16 (8:00 AM-9:00 AM)

Poster/Presentation
Number 10-004

Objective

To identify EEG-based indicators of delirium or coma in mechanically ventilated patients.

Background

Delirium during critical illness is associated with greater mortality, increased costs of care and long-term cognitive impairment. Delirium monitoring currently requires bedside assessment. Though delirium is associated with characteristic EEG findings, EEG-based technologies to monitor delirium are lacking.

Design/Methods We enrolled patients into a nested cohort study within 72 hours of ICU admission. Participants underwent 24-hour continuous EEG and twice daily delirium assessments using the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU). We computed 30 metrics evaluating the spectral profile, regional connectivity and complexity of the EEG. We used penalized regression to select EEG metrics associated with delirium or coma. We compared a mixed-effects model predicting delirium using clinical variables to a model incorporating the selected EEG metrics. In an ad hoc analysis, we computed a hypothetical delirium indicator as a linear combination of the selected EEG metrics and used the C-index to measure discrimination.

Results

We included 25 participants. Median (interquartile range [IQR]) age was 60 (50-72) years and 60% were male. Median APACHE II score was 31 (IQR 27-39). EEG was performed on study day 2 (IQR 1-2). We performed 50 RASS/CAM-ICU assessments, 20 during sedation. Coma was present in 21 (42%) and delirium in 11 (22%) assessments. We identified 4 EEG metrics that were altered during delirium or coma. The model including these metrics showed better prediction of delirium or coma than clinical variables alone (Akaike Information Criterion: 36 vs 43, p = 0.006 by likelihood ratio test). The area under the receiver operating characteristic curve for the hypothetical delirium indicator was 0.937 (95%CI 0.842-0.984).

Conclusions

In this nested cohort study of mechanically ventilated ICU patients, we identified four EEG metrics that, in combination, provided excellent discrimination between delirious/comatose and non-delirious patients.

Authors/Disclosures
Shawniqua Williams Roberson, MD PRESENTER	Dr. Williams Roberson has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology Today. The institution of Dr. Williams Roberson has received research support from the National Institute on Aging. The institution of Dr. Williams Roberson has received research support from Brain & Behavior Research Foundation. The institution of Dr. Williams Roberson has received research support from National Institute on Mental Health . Dr. Williams Roberson has received personal compensation in the range of $0-$499 for serving as a Visiting Speaker with University of Pennsylvania. Dr. Williams Roberson has received personal compensation in the range of $0-$499 for serving as a Faculty Speaker with the International Symposium for Intensive Care and Emergency Medicine.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Mayur Patel (Vanderbilt University Medical Center)	Mayur Patel has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for EAST. The institution of Mayur Patel has received research support from NIH & DoD. Mayur Patel has received intellectual property interests from a discovery or technology relating to health care. Mayur Patel has received personal compensation in the range of $500-$4,999 for serving as a Grant Review with NIH CSR.
	No disclosure on file
	No disclosure on file

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