Critical Care Optimized Pediatric and Neonatal Quantitative Neuromonitoring

Официальное название

Critical Care Optimized Pediatric Quantitative EEG

Обзор

The detection and appropriate treatment of seizures significantly impact the neurological prognosis of patients in intensive care. Indeed, altered brain function including seizures is described in critically ill children, regardless of the reason for admission. Most seizures are subclinical and therefore impossible to diagnose without neuromonitoring tools. Despite being concidered ad Gold Standard, continuous EEG (cEEG) with video recording shows difficulty of implementation and interpretation at all hours of the day and night explaining that less than 10% of centers in France use cEEG routinely. Most departments prefer simplified techniques, including amplitude traces (aEEG) which can be used continuously at the bedside. However, the positive predictive value of aEEG in the detection of seizures does not exceed 78% and 64% in newborns and children respectively making necessary an optimization of the information provided by these techniques. This project is a pragmatic diagnostic study that aims at developing and evaluating a neuromonitoring interface adapted to the needs of pediatric and neonatal intensive care units and meeting the requirements of neurophysiologists in terms of EEG trace quality.

Подробное описание

This research will take place in three phases :

1. Parameterization of the interface, which will display an 8-channel aEEG trace associated with reading aids (CDSA and automated seizure detection) available to the clinician. 2. Teams' training regarding the placement of additional electrodes and the use of reading aid tools. 3. Patient's inclusion. The obtained traces will be accessible at any time for direct interpretation and can be read on demand by a neurophysiologist during office hours.

Post-hoc review of the entire EEG trace by an expert in pediatric EEG, blinded to the interpretation made at the bedside (gold standard).

Research hypothesis is that continuous neuromonitoring combining optimized quantitative EEG techniques and targeted advice from a neurophysiologist would allow the detection of a majority of seizure events requiring treatment and background trace abnormalities associated with critical encephalopathy.

Вмешательства

• Другое Neuromonitoring with 10 electrodes
  In case of no parental objection, the clinician may begin neuromonitoring according to standard indications. The number of electrodes applied to the child's skull will be 10 electrodes (8 recording electrodes, 1 reference electrode, and 1 ground electrode) instead of the current 5. The intensivist will analyze the quantitative EEG trace as they currently do but will also have access to additional tools for seizure detection support (CDSA and seizure detection software) and targeted review of pa

Первичные конечные точки

• Evaluate the diagnostic performance of neuromonitoring combining quantitative EEG and possible interpretation by a neurophysiologist in detecting neurological impairment. [Срок оценки: 48 hours]

Вторичные конечные точки (6)

• Evaluation of the detection of convulsive seizures [Срок оценки: 48 hours]
• Evaluation of the classification of the background tracing in critical encephalopathy grade [Срок оценки: 48 hours]
• Impact of tracing aids on intensivists' confidence level during decision-making [Срок оценки: 48 hours]
• Number of suitable anticonvulsant treatments [Срок оценки: 48 hours]
• Prescription period for anticonvulsant treatments [Срок оценки: 48 hours]
• Hypothermia treatment rates indicated after subsequent rereading of the tracing by the expert [Срок оценки: 48 hours]

Критерии участия

Критерии включения

• Patients younger than 2 years old hospitalized in the intensive care unit with an indication for neuromonitoring. The same patient may be included multiple times.
• Written non-opposition from legal representatives.
• Patients affiliated with or beneficiaries of a social security or similar scheme (CMU).

Критерии исключения

• Parents who do not understand French.
• Inability to set up monitoring equipment (neurosurgery preventing access to electrode placement sites).
• Corrected age < 37 weeks of gestation (GA) for preterm infants.

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Модель наблюдения

Только случаи

Центры проведения

Франция · 1 центр

• CHU de Nantes — Nantes

Идентификаторы

NCT: NCT06726408 · RC24_0381 · N° ID-RCB : 2024-A01607-40

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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