Pilot Study Evaluating Bisprectral Electroencephalography During Resuscitation in Severe Sepsis

We conducted a prospective observational cohort study in a quaternary academic medical center ED between March and May of 2025. Non-pregnant, non-intubated adult ED patients with a severe sepsis alert (≥ 2 Systemic Inflammatory Response Syndrome criteria and either lactate ≥ 2 mmol/L or systolic blood pressure

Sepsis associated encephalopathy is associated with poor outcomes, but how it is affected by resuscitation is not clear. Bispectral electroencephalography (BSEEG) is a noninvasive thumb-sized device that processes brain activity, where higher BSEEG scores represent worse encephalopathy. We hypothesized that BSEEG scores would decrease during early emergency department (ED) resuscitation for severe sepsis.

Among 83 patients with severe sepsis alerts, 52 patients were excluded due to intubation (1), a preceding admission order (20), device unavailability (7), unreachable surrogates (3), and declined enrollment (21). Baseline demographics, lactate, and BSEEG scores were similar between septic (20) and non-septic (11) groups. In the septic group, BSEEG scores increased over time (β = 0.008 per hour; 95% CI 0.002 to 0.014) whereas no change occurred in the non-septic group (β = -0.005 per hour, 95% CI -0.012 to 0.003); in a combined model including all 31 patients, BSEEG trajectories increased over time in the septic group but remained stable in the non-septic group (time × sepsis interaction β = 0.013 per hour; 95% CI 0.003–0.022). Among 14 septic patients with initial lactate >2 mmol/L, poorer lactate clearance was associated with a more pronounced increase in BSEEG (β = 0.011; 95% CI 0.003 to 0.020).

Unlike the non-septic group, BSEEG scores increased for the septic group despite ED resuscitation, especially for patients with poor lactate clearance. A larger study with longer BSEEG monitoring is needed to assess for a possible delay of resuscitation impact on brain function.