2021 Annual Conference

CNS as Researcher

Significance/Background: Delirium increases the risk for long-term cognitive decline and mortality. This exploratory study evaluated the use of a limited lead EEG device for objective identification of delirium with the aim of early initiation of treatment. Specifically, are there reductions in alpha wave (awake wave) percentage with significant decreases in power, increases in theta wave (twilight sleep) and delta wave (deep sleep) percentage and power, and delta and theta wave intrusion that lead to a higher theta/alpha ratio and delta/alpha ratio in patients who are CAM-ICU positive, indicating delirium? 

Evaluation Methods: This prospective exploratory pilot study used a correlational design and mixed models to explore the relationships between hand-held portable EEG data and delirium status. To fully explore the data, several methods were utilized to evaluate differences in ratios between delirium positive and delirium negative subjects. Initial observations were treated as independent observations and all observations were explored using mixed models.

Outcomes: While this study did not find statistically significant differences there was a trend to higher ratios in subjects with delirium compared to those who did not have delirium when comparing only first observations and in mixed models controlling for random effects. In a sample size of 17 it is likely the sample sizes were too small to detect statistically significant differences. The fact that ratios were higher and were approaching significance is impressive and warrants further investigation.

Implications : Limited lead EEG may be useful in predicting adverse outcomes and risk for delirium in older critically ill patients. Therefore, further investigation of limited lead EEG for delirium detection is warranted. Until these devices can be validated, nurses should continue to use validated bedside clinical tools with frequent reeducation and competency validation to minimize practice drift.