Abstract
Sepsis is a potentially life-threatening condition caused by a systemic dysregulated host response to infection. The brain is particularly susceptible to the effects of sepsis with clinical manifestations ranging from mild confusion to a deep comatose state. Sepsis-associated delirium (SAD) is a cerebral manifestation commonly occurring in patients with sepsis and is thought to occur due to a combination of neuroinflammation and disturbances in cerebral perfusion, the blood brain barrier (BBB) and neurotransmission. The neurological impairment associated with SAD can persist for months or even longer, after the initial septic episode has subsided which may impair the rehabilitation potential of sepsis survivors. Early identification and treatment of the underlying sepsis is key in the management of SAD as once present it can be difficult to control. Through the regular use of validated screening tools for delirium, cases of SAD can be identified early; this allows potentially aggravating factors to be addressed promptly. The usefulness of biomarkers, neuroimaging and electroencephalopathy (EEG) in the diagnosis of SAD remains controversial. The Society of Critical Care Medicine (SCCM) guidelines advise against the use of medications to treat delirium unless distressing symptoms are present or it is hindering the patient’s ability to wean from organ support.
Highlights
Sepsis is a leading cause of morbidity and mortality around the world
There is still much to learn about the pathophysiology of Sepsis-associated delirium (SAD), it is currently understood to be a combination of neuroinflammation and disturbances in cerebral perfusion, the blood brain barrier
Endothelium forms a functional component of the blood brain barrier (BBB); its expression of adhesion molecules, production of nitric oxide (NO), signalling pathways and overall cellular integrity are affected by inflammatory cytokines, which are markedly elevated in sepsis [5]
Summary
Sepsis is a leading cause of morbidity and mortality around the world. It is a systemic, dysregulated, inflammatory reaction to an infection and can have profound effects on all organ systems which if left untreated often leads to multi-organ failure and death. The delicately balanced central nervous system is susceptible to dysfunction the mechanisms through which sepsis affects the brain are poorly understood and often underappreciated. Between a quarter and a third of septic patients show signs of neurological involvement including confusion, agitation and coma or “sepsis-associated delirium” (SAD). In this review article we will discuss the currently understood pathophysiology, diagnostic tools and management strategies for patients with SAD as well as potential future treatment options
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