Improving the benefit of processed EEG monitors: it’s not about the car but the driver

Introna, Michele; Gemma, Marco; Carozzi, Carla · 2023 · Crossref

DOI: 10.1007/s10877-023-01004-6

archive: archived pipeline: cataloged verified

Get this paper ↗ (DOI — opens at the source; we link to it, we don't host it)

Summary

This editorial addresses the limitations and clinical interpretation of processed electroencephalography (pEEG) monitors used for depth of anesthesia (DOA) monitoring. Motivated by a recent study by Han et al. comparing three proprietary commercial monitors—Patient State Index (PSI), Bispectral Index (BIS), and Entropy—during drug-induced sleep endoscopy with dexmedetomidine, the authors argue that reliance on pEEG indices alone poses significant risks. The Han study demonstrated that while all monitors correlated with the Richmond Agitation-Sedation Scale, BIS values were elevated during deep sedation likely due to electromyography (EMG) interference, whereas PSI and Entropy were less affected. This highlights that different devices perform variably depending on the clinical context and drug regimen, often failing to provide concordant readings. The authors emphasize that the core issue is not the technology itself but the clinician’s ability to interpret the data. They critique the oversimplification of consciousness into a single dimensionless number, referencing Sleigh’s metaphor that the brain functions more like a complex switchboard than a submarine diving to a specific depth. The editorial notes that manufacturers use proprietary, patented algorithms with different filtering methods (e.g., BIS uses 0.5–70 Hz bandwidth) to handle noise and muscle activity, leading to discordant clinical recommendations even when reading identical EEG traces. For instance, previous studies have shown that in one-third of cases, commercial monitors disagree on the depth of anesthesia, and in 31% of cases, at least one monitor indicated excessive hypnotic depth despite emergency-like EEG patterns. The primary finding is that clinicians must critically choose monitors based on their specific trade-offs between sensitivity and specificity, such as prioritizing early warnings of awareness even if it increases false positives from artifacts. More importantly, the authors advocate for mandatory training in interpreting raw EEG and EMG signals, similar to the requirement for electrocardiogram interpretation in anesthesiology. Clinicians must verify that the calculated pEEG index aligns with the raw signal and clinical context, such as drug dosages and patient parameters. For example, an increase in pEEG during propofol anesthesia accompanied by EMG activity should be interpreted as noxious stimulation or artifact rather than lightening anesthesia. The significance of this work lies in its call for a shift from passive reliance on automated indices to active, skilled interpretation of neurophysiological data. The authors conclude that while pEEG monitors have potential in both anesthesia and intensive care settings to prevent under- or over-sedation, their safe application requires transparent manufacturer disclosure of signal processing methods and rigorous clinician education. Without these steps, the heterogeneity of patient populations and physiological states will continue to render "magic number" targets ineffective and potentially dangerous.

Provenance

The full processing record for this entry. Every stage of this paper's journey through the pipeline is logged — what ran, with which tool and model, how many attempts it took, and when it last completed.

Summary generated by qwen3.6-27b-nvidia on 2026-08-10; verification: verified.

Topics

Ranked by relevance to this paper. Hover a topic for its definition.

• neuro workload indices