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STUDY AIM : To provide a consensus of European leading authorities about the optimal use of clinical neurophysiological (CN) tests (electroencephalogram [EEG]; evoked potentials [EP]; electroneuromyography [ENMG]) in the intensive care unit (ICU) and, particularly, about the way to make these tests clinically useful for the management of individual patients. METHODS : This study gathered together several European clinical neurophysiologists and neurointensivists whose leading contributions in the adult or paediatric ICU and in continuous neuromonitoring had been peer-acknowledged. It was based on both a literature review and each participant's own experience. Given the methodological impossibility to gather studies fulfilling criteria of evidence-based medicine, this article essentially relies on expert opinions that were gained after several rounds, in which each expert was invited to communicate his own contribution to all other experts. A complete consensus has been reached when submitting the manuscript. RESULTS : What the group considered as the best classification systems for EEG and EP abnormalities in the ICU is first presented. CN tests are useful for diagnosis (epilepsy, brain death, and neuromuscular disorders), prognosis (anoxic ischemic encephalopathy, head trauma, and neurologic disturbances of metabolic and toxic origin), and follow-up, in the adult, paediatric, and neonatal ICU. Regarding prognosis, a clear distinction is made between these tests whose abnormalities are indicative of an ominous prognosis and those whose relative normalcy is indicative of a good prognosis. The prognostic significance of any test may vary as a function of coma etiology. CONCLUSION : CN provides quantitative functional assessment of the nervous system. It can be used in sedated or curarized patients. Therefore, it should play a major role in the individual assessment of ICU patients., BUT DE L’ÉTUDE : Présenter l’avis consensuel d’un groupe d’experts européens à propos de l’utilisation optimale de la neurophysiologie clinique (électroencéphalogramme : EEG, potentiels évoqués : PE, électroneuromyographie [ENMG]) en unité de soins intensifs (USI) et, plus particulièrement, de la manière de maximiser l’utilité de ces tests dans la mise au point individuelle des patients. MÉTHODES : Cette étude a rassemblé plusieurs neurophysiologistes cliniciens et neurointensivistes européens dont la compétence en matière de neuroréanimation adulte ou pédiatrique et de neuromonitoring était unanimement reconnue par leurs pairs. Elle est basée à la fois sur une revue de la littérature et sur l’expérience de chaque participant. Vu l’impossibilité, d’ordre méthodologique, de rassembler des études satisfaisant les critères de la médecine factuelle, cet article repose essentiellement sur des opinions d’experts et un consensus atteint au bout de plusieurs « tours de table » lors desquels chaque expert était invité à soumettre sa propre contribution à l’opinion de tous les autres. RÉSULTATS : Nous présentons d’abord ce que le groupe a considéré comme les meilleurs systèmes de classification des anomalies EEG et PE en USI. Les tests neurophysiologiques sont utiles pour le diagnostic (épilepsie, mort cérébrale, anomalies neuromusculaires), le pronostic (encéphalopathies anoxo-ischémiques, traumatismes crâniens, dysfonctionnements neurologiques d’origine métabolique ou toxique) et le suivi, dans les USI adultes, pédiatriques et néonatales. Sur le plan du pronostic, il importe de bien distinguer les tests dont les anomalies sont indicatives d’un mauvais pronostic et ceux qui, lorsqu’ils sont relativement peu perturbés, impliquent un pronostic favorable. Un même test peut avoir une signification pronostique variable en fonction de l’étiologie du coma. CONCLUSION : La neurophysiologie clinique évalue fonctionnellement et quantitativement le système nerveux, même chez les patien

STUDY AIM: To provide a consensus of European leading authorities about the optimal use of clinical neurophysiological (CN) tests (electroencephalogram [EEG]; evoked potentials [EP]; electroneuromyography [ENMG]) in the intensive care unit (ICU) and, particularly, about the way to make these tests clinically useful for the management of individual patients. METHODS: This study gathered together several European clinical neurophysiologists and neurointensivists whose leading contributions in the adult or paediatric ICU and in continuous neuromonitoring had been peer-acknowledged. It was based on both a literature review and each participant's own experience. Given the methodological impossibility to gather studies fulfilling criteria of evidence-based medicine, this article essentially relies on expert opinions that were gained after several rounds, in which each expert was invited to communicate his own contribution to all other experts. A complete consensus has been reached when submitting the manuscript. RESULTS: What the group considered as the best classification systems for EEG and EP abnormalities in the ICU is first presented. CN tests are useful for diagnosis (epilepsy, brain death, and neuromuscular disorders), prognosis (anoxic ischemic encephalopathy, head trauma, and neurologic disturbances of metabolic and toxic origin), and follow-up, in the adult, paediatric, and neonatal ICU. Regarding prognosis, a clear distinction is made between these tests whose abnormalities are indicative of an ominous prognosis and those whose relative normalcy is indicative of a good prognosis. The prognostic significance of any test may vary as a function of coma etiology. CONCLUSION: CN provides quantitative functional assessment of the nervous system. It can be used in sedated or curarized patients. Therefore, it should play a major role in the individual assessment of ICU patients.