Cerebral perfusion in sepsis-associated deliriumReportar como inadecuado




Cerebral perfusion in sepsis-associated delirium - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Critical Care

, 12:R63

First Online: 05 May 2008Received: 15 January 2008Revised: 04 March 2008Accepted: 05 May 2008

Abstract

IntroductionThe pathophysiology of sepsis-associated delirium is not completely understood and the data on cerebral perfusion in sepsis are conflicting. We tested the hypothesis that cerebral perfusion and selected serum markers of inflammation and delirium differ in septic patients with and without sepsis-associated delirium.

MethodsWe investigated 23 adult patients with sepsis, severe sepsis, or septic shock with an extracranial focus of infection and no history of intracranial pathology. Patients were investigated after stabilisation within 48 hours after admission to the intensive care unit. Sepsis-associated delirium was diagnosed using the confusion assessment method for the intensive care unit. Mean arterial pressure MAP, blood flow velocity FV in the middle cerebral artery using transcranial Doppler, and cerebral tissue oxygenation using near-infrared spectroscopy were monitored for 1 hour. An index of cerebrovascular autoregulation was calculated from MAP and FV data. C-reactive protein CRP, interleukin-6 IL-6, S-100β, and cortisol were measured during each data acquisition.

ResultsData from 16 patients, of whom 12 had sepsis-associated delirium, were analysed. There were no significant correlations or associations between MAP, cerebral blood FV, or tissue oxygenation and sepsis-associated delirium. However, we found a significant association between sepsis-associated delirium and disturbed autoregulation P = 0.015. IL-6 did not differ between patients with and without sepsis-associated delirium, but we found a significant association between elevated CRP P = 0.008, S-100β P = 0.029, and cortisol P = 0.011 and sepsis-associated delirium. Elevated CRP was significantly correlated with disturbed autoregulation Spearman rho = 0.62, P = 0.010.

ConclusionIn this small group of patients, cerebral perfusion assessed with transcranial Doppler and near-infrared spectroscopy did not differ between patients with and without sepsis-associated delirium. However, the state of autoregulation differed between the two groups. This may be due to inflammation impeding cerebrovascular endothelial function. Further investigations defining the role of S-100β and cortisol in the diagnosis of sepsis-associated delirium are warranted.

Trial registrationClinicalTrials.gov NCT00410111.

AbbreviationsAPACHEAcute Physiology and Chronic Health Evaluation II

CAM-ICUconfusion assessment method for the intensive care unit

CBFcerebral blood flow

CRPC-reactive protein

FVflow velocity

IL-6interleukin-6

MAPmean arterial pressure

MRImagnetic resonance imaging

Mxindex of cerebrovascular autoregulation

NIRSnear-infrared spectroscopy

NSEneuron-specific enolase

PaCO2= arterial partial pressure of carbon dioxide

SPECTsingle photon emission computed tomography

TCDtranscranial Doppler

TOItissue oxygenation index.

Electronic supplementary materialThe online version of this article doi:10.1186-cc6891 contains supplementary material, which is available to authorized users.

Download fulltext PDF



Autor: David Pfister - Martin Siegemund - Salome Dell-Kuster - Peter Smielewski - Stephan Rüegg - Stephan P Strebel - Stephan CU

Fuente: https://link.springer.com/







Documentos relacionados