Somatosensory evoked potentials in patients with hypoxic-ischemic brain injury

Predicting the future of patients with hypoxic-ischemic encephalopathy after successful cardiopulmonary resuscitation is often difficult. Registration of the median nerve somatosensory evoked potential (SSEP) can assist in the neurologic evaluation in these patients. In this article, the authors discuss the principles, applications, and limitations of SSEP registration in the intensive care unit, with a focus on prognostication. Registration of the SSEP is a very reliable and reproducible method, if it is performed and interpreted correctly. During SSEP recordings, great care should be taken to improve the signal-to-noise ratio. If the noise level is too high, the peripheral responses are abnormal or the response is not reproducible in a second set of stimuli; therefore, interpretation of the SSEPs cannot be done reliably. A bilaterally absent cortical SSEP response is a very reliable predictor of poor neurologic outcome in patients with HIE. It has a high specificity, but a low sensitivity, indicating that present cortical responses are a weak predictor of a good recovery. Further research is being done to increase the sensitivity. Somatosensory evoked potentials can be used in a multimodal approach for prognostication of outcome.