Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis
Abstract Background Sepsis-associated brain dysfunction (SABD) is associated with high morbidity and mortality. The pathophysiology of SABD is multifactorial. One hypothesis is that impaired cerebral autoregulation (CAR) may result in brain hypoperfusion and neuronal damage leading to SABD. Methods...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-12-01
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| Series: | Critical Care |
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| Online Access: | http://link.springer.com/article/10.1186/s13054-018-2258-8 |
| _version_ | 1819263195139801088 |
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| author | Ilaria Alice Crippa Carles Subirà Jean-Louis Vincent Rafael Fernandez Fernandez Silvia Cano Hernandez Federica Zama Cavicchi Jacques Creteur Fabio Silvio Taccone |
| author_facet | Ilaria Alice Crippa Carles Subirà Jean-Louis Vincent Rafael Fernandez Fernandez Silvia Cano Hernandez Federica Zama Cavicchi Jacques Creteur Fabio Silvio Taccone |
| author_sort | Ilaria Alice Crippa |
| collection | DOAJ |
| description | Abstract Background Sepsis-associated brain dysfunction (SABD) is associated with high morbidity and mortality. The pathophysiology of SABD is multifactorial. One hypothesis is that impaired cerebral autoregulation (CAR) may result in brain hypoperfusion and neuronal damage leading to SABD. Methods We studied 100 adult patients with sepsis (July 2012–March 2017) (age = 62 [52–71] years; Acute Physiology and Chronic Health Evaluation II score on admission = 21 [15–26]). Exclusion criteria were acute or chronic intracranial disease, arrhythmias, extracorporeal membrane oxygenation, and known intra- or extracranial supra-aortic vessel disease. The site of infection was predominantly abdominal (46%) or pulmonary (28%). Transcranial Doppler was performed, insonating the left middle cerebral artery with a 2-MHz probe. Middle cerebral artery blood flow velocity (FV) and arterial blood pressure (ABP) signals were recorded simultaneously; Pearson’s correlation coefficient (mean flow index [Mxa]) between ABP and FV was calculated using MATLAB. Impaired CAR was defined as Mxa > 0.3. Results Mxa was 0.29 [0.05–0.62]. CAR was impaired in 50 patients (50%). In a multiple linear regression analysis, low mean arterial pressure, history of chronic kidney disease and fungal infection were associated with high Mxa. SABD was diagnosed in 57 patients (57%). In a multivariable analysis, altered cerebral autoregulation, mechanical ventilation and history of vascular disease were independent predictors of SABD. Conclusions Cerebral autoregulation was altered in half of the patients with sepsis and was associated with the development of SABD. These findings support the concept that cerebral hypoxia could contribute to the development of SABD. |
| first_indexed | 2024-12-23T20:09:43Z |
| format | Article |
| id | doaj.art-72c273770da6405aa52c171e432f624c |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-23T20:09:43Z |
| publishDate | 2018-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-72c273770da6405aa52c171e432f624c2022-12-21T17:32:51ZengBMCCritical Care1364-85352018-12-012211910.1186/s13054-018-2258-8Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsisIlaria Alice Crippa0Carles Subirà1Jean-Louis Vincent2Rafael Fernandez Fernandez3Silvia Cano Hernandez4Federica Zama Cavicchi5Jacques Creteur6Fabio Silvio Taccone7Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB)Department of Intensive Care, Althaia Xarxa Assistencial Universitària de ManresaDepartment of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB)Department of Intensive Care, Althaia Xarxa Assistencial Universitària de ManresaDepartment of Intensive Care, Althaia Xarxa Assistencial Universitària de ManresaDepartment of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB)Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB)Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB)Abstract Background Sepsis-associated brain dysfunction (SABD) is associated with high morbidity and mortality. The pathophysiology of SABD is multifactorial. One hypothesis is that impaired cerebral autoregulation (CAR) may result in brain hypoperfusion and neuronal damage leading to SABD. Methods We studied 100 adult patients with sepsis (July 2012–March 2017) (age = 62 [52–71] years; Acute Physiology and Chronic Health Evaluation II score on admission = 21 [15–26]). Exclusion criteria were acute or chronic intracranial disease, arrhythmias, extracorporeal membrane oxygenation, and known intra- or extracranial supra-aortic vessel disease. The site of infection was predominantly abdominal (46%) or pulmonary (28%). Transcranial Doppler was performed, insonating the left middle cerebral artery with a 2-MHz probe. Middle cerebral artery blood flow velocity (FV) and arterial blood pressure (ABP) signals were recorded simultaneously; Pearson’s correlation coefficient (mean flow index [Mxa]) between ABP and FV was calculated using MATLAB. Impaired CAR was defined as Mxa > 0.3. Results Mxa was 0.29 [0.05–0.62]. CAR was impaired in 50 patients (50%). In a multiple linear regression analysis, low mean arterial pressure, history of chronic kidney disease and fungal infection were associated with high Mxa. SABD was diagnosed in 57 patients (57%). In a multivariable analysis, altered cerebral autoregulation, mechanical ventilation and history of vascular disease were independent predictors of SABD. Conclusions Cerebral autoregulation was altered in half of the patients with sepsis and was associated with the development of SABD. These findings support the concept that cerebral hypoxia could contribute to the development of SABD.http://link.springer.com/article/10.1186/s13054-018-2258-8Doppler sonographyTranscranialCerebrovascular circulationCerebral blood flowBrain dysfunction |
| spellingShingle | Ilaria Alice Crippa Carles Subirà Jean-Louis Vincent Rafael Fernandez Fernandez Silvia Cano Hernandez Federica Zama Cavicchi Jacques Creteur Fabio Silvio Taccone Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis Critical Care Doppler sonography Transcranial Cerebrovascular circulation Cerebral blood flow Brain dysfunction |
| title | Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
| title_full | Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
| title_fullStr | Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
| title_full_unstemmed | Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
| title_short | Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
| title_sort | impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
| topic | Doppler sonography Transcranial Cerebrovascular circulation Cerebral blood flow Brain dysfunction |
| url | http://link.springer.com/article/10.1186/s13054-018-2258-8 |
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