Abstract
Sepsis-associated brain dysfunction (SABD) may be the most common type of encephalopathy in critically ill patients. SABD develops in up to 70% of septic patients and represents the most frequent organ insufficiency associated with sepsis. It presents with a plethora of acute neurological features and may have several serious long-term psychiatric consequences. SABD might cause various pathological changes in the brain through numerous mechanisms. Clinical neurological examination is the basic screening method for SABD, although it may be challenging in subjects receiving with opioids and sedative agents. As electrographic seizures and periodic discharges might be present in 20% of septic patients, screening with electroencephalography (EEG) might be useful. Several imaging techniques have been suggested for non-invasive assessment of structure and function of the brain in SABD patients; however, their usefulness is rather limited. Although several experimental therapies have been postulated, at the moment, no specific treatment exists. Clinicians should focus on preventive measures and optimal management of sepsis. This review discusses epidemiology, clinical presentation, pathology, pathophysiology, diagnosis, management, and prevention of SABD.
Highlights
Significant progress has recently been made in increasing awareness among healthcare providers and in recognition and management [1], sepsis and septic shock remain a major healthcare problem worldwide
intensive care units (ICUs) hospitalizations in a 3-year period reported sepsis-associated encephalopathy (SAE) in 17.7% of patients; this study was based on an old definition of sepsis (2011), lacked precise diagnostic criteria for Sepsis-associated brain dysfunction (SABD), and patients receiving sedative agents were excluded [8]
Experimental research suggests that neuronal loss and reduced cholinergic signaling is responsible for the long-term consequences of SABD [8]
Summary
Significant progress has recently been made in increasing awareness among healthcare providers and in recognition and management [1], sepsis and septic shock remain a major healthcare problem worldwide. According to the most recent consensus, sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection [2]. As intensive care units (ICUs) are well placed for managing organ failures, sepsis is a frequent ICU admission diagnosis [3]. One of the organs affected in sepsis is the brain, and sepsis-associated brain dysfunction (SABD) is probably the most common type of encephalopathy in the ICU. SABD is defined as diffuse brain dysfunction caused by infection outside the central nervous system (CNS) and is a diagnosis of exclusion. SABD might develop in up to 70% of septic patients [4], especially in patients with confirmed bacteremia [5], and represents the most frequent organ insufficiency associated with sepsis [6]. Public Health 2020, 17, 5852; doi:10.3390/ijerph17165852 www.mdpi.com/journal/ijerph
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