Zhengsong Shi, Ming Li, Hongguang Li, Qianlin Wang, Yang Yingying, Fang Wang, Huan Chen, Yun Long, Yuechuan Xue
A computationally derived 4-electrode montage (F3, F4, F7, and F8) demonstrates close agreement with the 16-electrode reference for global qEEG trend parameters in deeply sedated post-cardiac surgery patients. These findings provide a computational basis for designing a future standalone reduced-electrode acquisition system. Prospective validation with independent hardware is required before clinical deployment, and diagnostic performance for focal events remains to be established.
OBJECTIVE: Neurologic complications after cardiac surgery are common and associated with high morbidity and mortality. Continuous electroencephalography (cEEG) provides the reference standard for brain monitoring, but the standard 19-lead setup is difficult to implement routinely in the intensive care unit (ICU). Simplified EEG montages derived from high-density recordings were computationally evaluated to identify a configuration that preserves quantitative EEG (qEEG) fidelity for global brain state trend assessment at the bedside.
DESIGN: A retrospective, observational validation study.
SETTING: Single-center cardiac surgical ICU.
PARTICIPANTS: Twenty-six patients admitted to the ICU for at least 24 hours following cardiac surgery with cardiopulmonary bypass, all under deep sedation (Richmond Agitation-Sedation Scale -4) during EEG recording.
INTERVENTIONS: Computational extraction of reduced-lead configurations (2-lead, three 4-lead combinations, and 6-lead) from 16-lead reference EEG recordings.
MEASUREMENTS AND MAIN RESULTS: Both 4-lead and 6-lead configurations showed good to excellent agreement with the reference. The 4-lead F3+F4+F7+F8 montage achieved excellent reliability intraclass coefficient (>0.9) for 9 of 10 qEEG parameters, with performance comparable to the 6-lead configuration. Bland-Altman analysis showed small bias and acceptable 95% limits of agreement for key parameters.
CONCLUSIONS: A computationally derived 4-electrode montage (F3, F4, F7, and F8) demonstrates close agreement with the 16-electrode reference for global qEEG trend parameters in deeply sedated post-cardiac surgery patients. These findings provide a computational basis for designing a future standalone reduced-electrode acquisition system. Prospective validation with independent hardware is required before clinical deployment, and diagnostic performance for focal events remains to be established.