Technology is great when it works!
Has this happened to you? You set up your aEEG monitor, you apply your electrodes, anxiously await your tracing to start forming and then…ugh, what is going on with my tracing? We’ve all been there.
Like any technology, brain monitoring tools can be bewildering at times, but armed with knowledge and some pro-tips, you will be ready to tackle your aEEG issues with confidence.
During the 2019 ONE Conference, I broke down the Top 5 Factors that influence aEEG, or any brain monitoring tool for that matter!
LET’S DIVE IN
The factors that influence brain monitoring tools and impact the quality of your tracing can be broken down into 5 categories; the 5 M’s:
Luckily most aEEG monitors are reliable work-horses in the NICU, need little maintenance and rarely fail, even after years and years of use and abuse.
The most common mechanical issue when using aEEG comes from the application of electrodes. To troubleshoot these issues make sure your sensors are connected and secured well and your impedance is low. Need some pro-tips on lowering impedance? Check out my free aEEG e-book HERE.
Brain maturation impacts the background pattern of your aEEG. The aEEG tracing matures as the brain matures.
If you monitor preterm babies you will see a discontinuous pattern (with a lower margin of less than 5 microvolts) and if you monitor a term baby, you will see hopefully see a continuous pattern (with a lower margin of greater than 5 microvolts).
The effects of neuro-active medications can clearly be seen in aEEG tracings.
For example, phenobarbital can cause a decrease in the lower margin to below 5 microvolts for about 30 to 60 minutes after a loading dose. There are many case reports of changes seen on aEEG after sedation and surfactant too.
Metabolic diseases that are untreated or undiagnosed can cause nonspecific changes in aEEG patterns that match the infant’s clinical presentation. Infants who have inborn errors of metabolism and are monitored with aEEG typically display a depressed background pattern of activity and may have subclinical seizures. Both background EEG activity and seizures will improve as the condition is managed and more under control.
MEDICAL EMERGENCIES & OTHER CONDITIONS
Acutely ill neonates, such as those with congenital heart disease (CHD) or persistent pulmonary hypertension (PPHN) may demonstrate abnormal aEEG tracings even with normal neurologic exams.
Which of these 5 things make your use of aEEG the most frustrating?
Do you have any tips and tricks to share with our community? We love hearing from you.
Want a deeper dive in to managing neuromonitoring challenges? Access the full recording of my Advanced aEEG lecture and more at the 2019 ONE Conference.