Table 4.

Competency to use and training the principles of pEEG monitoring: outcome of Delphi process for training and competencies statements

Statement	DI	Median AS	Stopping rulea	Conclusion
1. pEEG monitoring should be considered as a specialized specific monitoring technique	0.388	8	Rd 2	Highly appropriate/strong consensus
2 pEEG monitoring competencies are required only by neurointensivists or neuroanesthesiologists	1.53	5	Rd 2	No consensus
3. pEEG monitoring competencies are required by every category of intensivist	0.149	8	Rd 2	Highly appropriate/strong consensus
4. pEEG monitoring competencies are required by every category of anesthesiologist	0.140	8	Rd 2	Highly appropriate/strong consensus
5. For pEEG monitoring in ICU patients, it would be advantageous to define a universal method of implementation and evaluation irrespective of the patient’s characteristics, the sedation used, and whether pharmacological or neurological aspects were considered	0.009	8	Rd 2	Highly appropriate/strong consensus
6. In addition to EEG pattern recognition and the quantitative multiparameter approach, graphical displays of trends and/or spectrograms are useful for intercurrent event or problem detection	0	9	Rd 2	Highly appropriate/strong consensus
7. In addition to EEG pattern recognition and the quantitative multiparameter approach, graphical displays of trends and/or spectrograms are useful for identification of the patient’s neurophysiological status or trends in the neurophysiological status	0	9	Rd 2	Highly appropriate/strong consensus
8. In addition to EEG pattern recognition and the quantitative multiparameter approach, graphical displays of trends and/or spectrograms are useful for setting and adjusting sedative medication	0	9	Rd 2	Highly appropriate/strong consensus
9. In the short term, there is a need for structured fellowship programs to enable acquisition of pEEG monitoring competencies	0.132	9	Rd 2	Highly appropriate/strong consensus
10. In the longer term, pEEG monitoring competencies should be an integral part of postgraduate training programs in intensive care	0.132	9	Rd 2	Highly appropriate/strong consensus
11. Written and/or oral examinations appropriate to evaluate defined learning objectives are an essential component of the assessment of pEEG monitoring competencies	0.164	8	Rd 2	Highly appropriate/strong consensus
12. The successful supervised management of a predefined number of cases is an essential component of the assessment of pEEG monitoring competencies	0.132	9	Rd 2	Highly appropriate/strong consensus
13. Final evaluation of competencies in the clinical setting should include use of a global rating scale	0.132	8	Rd 2	Highly appropriate/strong consensus
14. Training in pEEG monitoring can be successfully delivered entirely in the clinical setting	0.357	7	Rd 2	Appropriate/strong consensus
15. Clinical training in pEEG monitoring should be complemented with “classroom” teaching of the theoretical (physics, neurophysiological, pharmacological, pathological, etc.) aspects	0.132	9	Rd 2	Highly appropriate/strong consensus
16. Rapid recognition of typical patterns of the raw EEG trace at the patient’s bedside aids timely clinical decision-making	0.132	9	Rd 2	Highly appropriate/strong consensus
17. The required competencies for routine pEEG monitoring in ICU are limited to assessment of the effects of sedative medication (pharmaco-EEG and/or pharmaco-pEEG)	0.164	3	Rd 2	Inappropriate/strong consensus
18. pEEG monitoring training would benefit by using the approaches successfully applied to other specialized monitoring/diagnostic techniques, such as transthoracic and/or transesophageal echocardiography	0	8	Rd 2	Highly appropriate/strong consensus
19. Programs of training for pEEG monitoring would benefit from including neurospecialists (neurologist, epilepsy specialist) on the faculty	0.132	9	Rd 2	Highly appropriate/strong consensus
20. New learning resources will need to be developed specifically to support training for pEEG monitoring in the ICU	0.132	9	Rd 2	Highly appropriate/strong consensus
21. The intensivist certified in pEEG monitoring should demonstrate regular continuing professional development activities relevant to pEEG monitoring	0.132	8	Rd 2	Highly appropriate/strong consensus
22. The intensivist certified in pEEG monitoring requires regular recertification in pEEG monitoring	0.164	8	Rd 2	Highly appropriate/strong consensus
23. Recertification of the intensivist certified in pEEG monitoring should be based on review of cases that demonstrate required competencies	0.195	8	Rd 2	Highly appropriate/strong consensus
24. Recertification of the intensivist certified in pEEG monitoring should be based on a written examination	1.61	7	Rd 2	No consensus
25. Recertification of the intensivist certified in pEEG monitoring should be based on review of cases that demonstrate required competencies and a written examination	0.678	8	Rd 2	Highly appropriate/weak consensus
26. In the absence of a system of internal support, external support for the intensivist certified in pEEG monitoring must include the capability for real-time input from a neuro-ICU specialist, neurologist, or neurophysiologist if necessary	0.031	8	Rd 2	Highly appropriate/strong consensus
27. Frequency domain analysis of the EEG signal is useful when monitoring ICU patients	0.009	8	Rd 2	Highly appropriate/strong consensus
28. Time domain analysis of the EEG signal is useful when monitoring ICU patients	0.126	8	Rd 2	Highly appropriate/strong consensus
29. Power domain analysis of the EEG signal is useful when monitoring ICU patients	0	8	Rd 2	Highly appropriate/strong consensus

List of all voted statements with level of agreement and level of consensus

AS, Appropriateness Score; DI, Disagreement Index; ICU, intensive care unit; EEG, electroencephalography; pEEG, processed electroencephalography

^aRound (Rd) of the Delphi process after which a stopping rule was reached