Frontotemporal EEG to guide sedation in COVID-19 related acute respiratory distress syndrome

Michalak, Andrew J.; Mendiratta, Anil; Eliseyev, Andrey; Ramnath, Brian; Chung, Jane; Rasnow, Jarret; Reid, Lawrence; Salerno, Steven; García, Paul S.; Agarwal, Sachin; Roh, David; Park, Soojin; Bazil, Carl; Claassen, Jan

Objective To study if limited frontotemporal electroencephalogram (EEG) can guide sedation changes in highly infectious novel coronavirus disease 2019 (COVID-19) patients receiving neuromuscular blocking agent. Methods 98 days of continuous frontotemporal EEG from 11 consecutive patients was evaluated daily by an epileptologist to recommend reduction or maintenance of the sedative level. We evaluated the need to increase sedation in the 6 hours following this recommendation. Post-hoc analysis of the quantitative EEG was correlated with the level of sedation using a machine learning algorithm. Results Eleven patients were studied for a total of ninety-eight sedation days. EEG was consistent with excessive sedation on 57 (58%) and adequate sedation on 41 days (42%). Recommendations were followed by the team on 59% (N=58; 19 to reduce and 39 to keep the sedation level). In the 6 hours following reduction in sedation, increases of sedation were needed in 7 (12%). Automatized classification of EEG sedation levels reached 80% (±17%) accuracy. Conclusions Visual inspection of a limited EEG helped sedation depth guidance. In a secondary analysis, our data supported that this determination may be automated using quantitative EEG analysis. Significance Our results support the use of frontotemporal EEG for guiding sedation in patients with COVID-19.