Klinische Neurophysiologie auf der pädiatrischen Intensivstation

Zusammenfassung

Auf pädiatrischen Intensivstationen kommt es häufig zum Einsatz neurophysiologischer Untersuchungsmethoden. Bei akuten Enzephalopathien oder in Situationen, in denen ein hohes Risiko für epileptische Anfälle besteht, werden verschiedene Varianten des EEGs verwendet. Bei Hinweisen auf neuromuskuläre Erkrankungen sind die Neurographie, die evozierten Potentiale, und die Elektromyographie die entscheidenden diagnostischen Methoden. Im Falle erworbener Hirnschädigungen wie z. B. nach Reanimationsereignissen oder bei Schädel-Hirn-Traumata können sowohl das EEG, als auch die evozierten Potentiale zur Prognoseabschätzung verwendet werden. Die Umstände auf der Intensivstation erschweren bei all diesen Methoden die Durchführung und die Interpretation. Viele Patienten werden mit Medikamenten behandelt, die die Untersuchungsergebnisse beeinflussen (insbesondere Sedativa und Muskelrelaxantien). Elektronische Geräte, z. B. für die Beatmung der Patienten, können zum Auftreten deutlicher Artefakte bei den neurophysiologischen Untersuchungen führen. Im vorliegenden Artikel werden die Einsatzbereiche neurophysiologischer Methoden auf pädiatrischen Intensivstationen beschrieben und auf Details bei der Anwendung eingegangen.

Abstract

Clinical neurophysiology methods are frequently employed on pediatric intensive care units. Electroencephalography is an important cornerstone in the evaluation of acute encephalopathies and in situations where an increased risk for cerebral seizures has to be assumed. Nerve conduction studies, electromyography, and evoked potentials are the decisive diagnostic tools in the case of suspected neuromuscular disorders. In the context of acquired brain lesions, e. g. after cardiac arrest or traumatic brain injuries, both the EEG and the evoked potentials are used to assess the prognosis of the patients. The ICU setting leads to additional difficulties in both the execution and the interpretation of all neurophysiological examination methods. Some of the medications used on ICUs, especially sedatives and neuromuscular-blocking drugs, directly influence the results of the examinations. The multitude of electronic devices that are used on ICUs (e. g. ventilators) are a source of technical artifacts that contaminate the neurophysiologic measurements. The article presented here summarizes the use of neurophysiological examinations on the ICU and gives some details regarding their application in this setting.

Schlüsselwörter

Neurophysiologie - Pädiatrie - Intensivstation

Key words

Neurophysiology - pediatrics - intenisve care unit

Publication History

Article published online:
13 September 2021

• Literatur

• 1 Amantini A, Carrai R, Lori S. et al Neurophysiological monitoring in adult and pediatric intensive care. Minerva Anestesiol 2012; 78: 1067-1075
• 2 Korinthenberg R, Trollmann R, Felderhoff-Müser U. et al Diagnosis and treatment of Guillain-Barré Syndrome in childhood and adolescence: An evidence- and consensus-based guideline. Eur J Paediatr Neurol 2020; 25: 5-16 doi:10.1016/j.ejpn.2020.01.003
• 3 Vucic S, Cairns KD, Black KR. et al Neurophysiologic findings in early acute inflammatory demyelinating polyradiculoneuropathy. Clin Neurophysiol 2004; 115: 2329-2335 doi:10.1016/j.clinph.2004.05.009
• 4 Uncini A, Kuwabara S. The electrodiagnosis of Guillain-Barré syndrome subtypes: Where do we stand?. Clin Neurophysiol 2018; 129: 2586-2593 doi:10.1016/j.clinph.2018.09.025
• 5 Thabet Mahmoud A, Tawfik MAM, Abd El Naby SA. et al Neurophysiological study of critical illness polyneuropathy and myopathy in mechanically ventilated children; additional aspects in paediatric critical illness comorbidities. Eur J Neurol 2018; 25: 991-e976 doi:10.1111/ene.13649
• 6 Kasinathan A, Sharawat IK, Singhi P. et al Intensive Care Unit-Acquired Weakness in Children: A Prospective Observational Study Using Simplified Serial Electrophysiological Testing (PEDCIMP Study). Neurocrit Care 2020; 1-8 doi:10.1007/s12028-020-01123-x
• 7 Vondracek P, Bednarik J. Clinical and electrophysiological findings and long-term outcomes in paediatric patients with critical illness polyneuromyopathy. Eur J Paediatr Neurol 2006; 10: 176-181 doi:10.1016/j.ejpn.2006.05.006
• 8 Field-Ridley A, Dharmar M, Steinhorn D. et al ICU-Acquired Weakness Is Associated With Differences in Clinical Outcomes in Critically Ill Children. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 2016; 17: 53-57 doi:10.1097/pcc.0000000000000538
• 9 Azapağası E, Kendirli T, Öz-Tuncer G. et al Complete paralytic botulism mimicking a deep coma in a child. Turk J Pediatr 2017; 59: 581-585 doi:10.24953/turkjped.2017.05.012
• 10 Kongsaengdao S, Samintarapanya K, Rusmeechan S. et al Electrophysiological diagnosis and patterns of response to treatment of botulism with neuromuscular respiratory failure. Muscle & nerve 2009; 40: 271-278 doi:10.1002/mus.21256
• 11 Arican P, Gencpinar P, Cavusoglu D. et al Clinical and Genetic Features of Congenital Myasthenic Syndromes due to CHAT Mutations: Case Report and Literature Review. Neuropediatrics 2018; 49: 283-288 doi:10.1055/s-0038-1654706
• 12 Boussuges A, Rives S, Finance J. et al Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives. World J Clin Cases 2020; 8: 2408-2424 doi:10.12998/wjcc.v8.i12.2408
• 13 Muller-Felber W, Riepl R, Reimers CD. et al Combined ultrasonographic and neurographic examination: a new technique to evaluate phrenic nerve function. Electromyography and clinical neurophysiology 1993; 33: 335-340
• 14 Carrai R, Grippo A, Lori S. et al Prognostic value of somatosensory evoked potentials in comatose children: a systematic literature review. Intensive care medicine 2010; 36: 1112-1126 doi:10.1007/s00134-010-1884-7
• 15 Carter BG, Butt W. A prospective study of outcome predictors after severe brain injury in children. Intensive care medicine 2005; 31: 840-845 doi:10.1007/s00134-005-2634-0
• 16 Carter BG, Butt W. Are somatosensory evoked potentials the best predictor of outcome after severe brain injury? A systematic review. Intensive care medicine 2005; 31: 765-775 doi:10.1007/s00134-005-2633-1
• 17 Schalamon J, Singer G, Kurschel S. et al Somatosensory evoked potentials in children with severe head trauma. Eur J Pediatr 2005; 164: 417-420 doi:10.1007/s00431-005-1656-5
• 18 Bosco E, Marton E, Feletti A. et al Dynamic monitors of brain function: a new target in neurointensive care unit. Crit Care 2011; 15: R170 doi:10.1186/cc10315
• 19 Mandel R, Martinot A, Delepoulle F. et al Prediction of outcome after hypoxic-ischemic encephalopathy: a prospective clinical and electrophysiologic study. J Pediatr 2002; 141: 45-50 doi:10.1067/mpd.2002.125005