Comparison of Narcotrend and Cerebral Function Analysing Monitor in Intensive Care to Monitor Seizures and Deep Sedation

NCT ID: NCT06067750

Last Updated: 2025-07-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

44 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-06-27

Study Completion Date

2024-05-25

Brief Summary

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A study in the use of the Narcotrend depth of anaesthesia monitor to record a) seizures, and b) monitor a level of sedation referred to as 'burst suppression', in sedated patients in the adult and paediatric intensive care.

Studies have shown that patients in coma on the intensive care unit may have subclinical in addition to clinical seizures. Subclinical seizures are seizures that do not show any outward signs and may go undetected.

The current gold standard of recording seizures in the intensive care unit is by non-invasive, continuous monitoring of the electrical activity of the brain by electroencephalography (cEEG) using cerebral function analysing monitor (CFAM).

This is recorded with simultaneous video recording and is performed by Clinical Neurophysiology departments.

There has been a steady increase in demand for this service over recent years. Additionally, CFAM / cEEG is labour intensive and expensive. If trends continue, the proportion of hospitals offering CFAM / cEEG will continue to rise, creating increased demand for specialist staff, of which there are a finite number.

Depth of anaesthesia monitors are used by anaesthetists to assess the level of anaesthesia in sedated patients using specialised, automated EEG analysis and are now recommended by NICE (DG6) to tailor anaesthetic dose to individual patients.

This study aims to investigate the utility of the Narcotrend depth of anaesthesia monitor to monitor for seizures and burst suppression on the adult and paediatric intensive care unit. These monitors are cheaper and more widely available with the scope to be used at every bed space requiring neuro observation on the intensive care unit.

The study aims to recruit all patients who are referred for CFAM / cEEG monitoring at Nottingham University Hospitals (NUH) Trust over a 12 month period. These patients will undergo simultaneous recording using CFAM / cEEG and depth of anaesthesia monitoring.

Detailed Description

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A non-invasive, prospective, observational, qualitative, comparative study performed on the adult and paediatric intensive care unit of NUH Trust. Study population will be all adult and paediatric patients referred for CFAM monitoring, including, but not limited to patients who are at risk of seizures due to status epilepticus, haemorrhage and traumatic brain injury.

Conditions

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Traumatic Brain Injury Subarachnoid Hemorrhage Intracerebral Haemorrhage Encephalitis Acute Ischemic Stroke Status Epilepticus Seizures Subdural Hematoma ICP (Intracranial Pressure) Increase

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

PROSPECTIVE

Study Groups

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Patients referred to Clinical Neurophysiology for Cerebral Function Analysing Monitoring (CFAM)

Patients referred from both adult and paediatric intensive care units

Narcotrend compared to Cerebral Function Analysing Monitor (CFAM)

Intervention Type DIAGNOSTIC_TEST

All patients will receive Narcotrend and CFAM monitoring in this observational study

Interventions

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Narcotrend compared to Cerebral Function Analysing Monitor (CFAM)

All patients will receive Narcotrend and CFAM monitoring in this observational study

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

Intensive care CFAM is recommended but not confined to identify non-convulsive seizures and non-convulsive status epilepticus (NCSE) in critically ill patients with the following:

1. Persistently abnormal mental status following generalised convulsive status epilepticus (GCSE) or other clinically evident seizures.
2. Acute supratentorial brain injury with altered mental status. This includes traumatic brain injury, subarachnoid hemorrhage, intracerebral hemorrhage, encephalitis, acute ischemic stroke, and during and after therapeutic hypothermia following cardiac arrest.
3. Fluctuating mental status or unexplained alteration of mental status without known acute brain injury: Mental status abnormalities can include agitation, lethargy, fixed or fluctuating neurologic deficits such as aphasia or neglect, obtundation, and coma.
4. Patients requiring pharmacological paralysis and risk for seizures.
5. Clinical paroxysmal events suspected to be seizures, to determine whether they are ictal or non-ictal
6. Patients with suggested secondary brain injury e.g. those with increased intracranial pressure.
7. Monitoring of the response of seizures and status epilepticus to treatment and to a level of burst suppression

Exclusion Criteria

1. Patients where CFAM has been requested but a routine EEG is thought to be more appropriate, eg. in cases where a routine 20 minute EEG would answer the clinical / referral question.
2. Next of kin will not be approached to consent for the patient to be enrolled into the study where clinical condition dictates that it would not be appropriate eg. imminent withdrawal of care.
3. Participants will be excluded from the study where consent is not granted or withdrawn. This may be at commencement of the study by parents of paediatric patients or next of kin of adult patients.
4. Data gained from patients who regain capacity to give retrospective consent and then withdraw will also be excluded.
Minimum Eligible Age

1 Month

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Nottingham University Hospitals NHS Trust

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Helen Sneath, DClinSci-stu

Role: PRINCIPAL_INVESTIGATOR

NUH

Ziad Alrifai, MBChB(Hons)

Role: STUDY_DIRECTOR

Nottingham University Hospitals Trust

Locations

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Nottingham University Hospitals Trust

Nottingham, Nottinghamshire, United Kingdom

Site Status

Countries

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United Kingdom

References

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Bader MK, Arbour R, Palmer S. Refractory increased intracranial pressure in severe traumatic brain injury: barbiturate coma and bispectral index monitoring. AACN Clin Issues. 2005 Oct-Dec;16(4):526-41. doi: 10.1097/00044067-200510000-00009.

Reference Type BACKGROUND
PMID: 16269897 (View on PubMed)

Arbour RB, Dissin J. Predictive value of the bispectral index for burst suppression on diagnostic electroencephalogram during drug-induced coma. J Neurosci Nurs. 2015 Apr;47(2):113-22. doi: 10.1097/JNN.0000000000000124.

Reference Type BACKGROUND
PMID: 25629593 (View on PubMed)

Berger-Estilita J, Steck K, Vetter C, Seidel K, Krejci V, Hight D, Kaiser H. A case report of several intraoperative convulsions while using the Narcotrend monitor: Significance and predictive use. Medicine (Baltimore). 2019 Nov;98(47):e18004. doi: 10.1097/MD.0000000000018004.

Reference Type BACKGROUND
PMID: 31764814 (View on PubMed)

Dahaba AA, Liu DW, Metzler H. Bispectral index (BIS) monitoring of acute encephalitis with refractory, repetitive partial seizures (AERRPS). Minerva Anestesiol. 2010 Apr;76(4):298-301.

Reference Type BACKGROUND
PMID: 20332745 (View on PubMed)

Dwivedi D, Bhatnagar V, Kiran S, Ray A. Intraoperative seizures during redo cranioplasty for sinking skin flap syndrome- Role of BIS monitor in detection. Saudi J Anaesth. 2017 Jul-Sep;11(3):359-360. doi: 10.4103/sja.SJA_44_17. No abstract available.

Reference Type BACKGROUND
PMID: 28757846 (View on PubMed)

Iturri Clavero F, Tamayo Medel G, de Orte Sancho K, Gonzalez Uriarte A, Iglesias Martinez A, Martinez Ruiz A. Use of BIS VISTA bilateral monitor for diagnosis of intraoperative seizures, a case report. Rev Esp Anestesiol Reanim. 2015 Dec;62(10):590-5. doi: 10.1016/j.redar.2015.03.006. Epub 2015 May 3.

Reference Type BACKGROUND
PMID: 25944463 (View on PubMed)

Tallach RE, Ball DR, Jefferson P. Monitoring seizures with the Bispectral index. Anaesthesia. 2004 Oct;59(10):1033-4. doi: 10.1111/j.1365-2044.2004.03953.x. No abstract available.

Reference Type BACKGROUND
PMID: 15488073 (View on PubMed)

Other Identifiers

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21IT001

Identifier Type: -

Identifier Source: org_study_id

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