The Use of Near-Infrared Spectroscopy and/or Transcranial Doppler as Non-Invasive Markers of Cerebral Perfusion in Adult Sepsis Patients With Delirium: A Systematic Review.

Michael D Wood,Donald E G Griesdale,Amanda Ross-White,Denise Foster,James Frank,Nicole Wood,Akash Chopra,Timothy D Girard,J Gordon Boyd

doi:10.1177/0885066621997090

Abstract

Background:Several studies have previously reported the presence of altered cerebral perfusion during sepsis. However, the role of non-invasive neuromonitoring, and the impact of altered cerebral perfusion, in sepsis patients with delirium remains unclear.Methods:We performed a systematic review of studies that used near-infrared spectroscopy (NIRS) and/or transcranial Doppler (TCD) to assess adults (≥18 years) with sepsis and delirium. From study inception to July 28, 2020, we searched the following databases: Ovid MedLine, Embase, Cochrane Library, and Web of Science.Results:Of 1546 articles identified, 10 met our inclusion criteria. Although NIRS-derived regional cerebral oxygenation was consistently lower, this difference was only statistically significant in one study. TCD-derived cerebral blood flow velocity was inconsistent across studies. Importantly, both impaired cerebral autoregulation during sepsis and increased cerebrovascular resistance were associated with delirium during sepsis. However, the heterogeneity in NIRS and TCD devices, duration of recording (from 10 seconds to 72 hours), and delirium assessment methods (e.g., electronic medical records, confusion assessment method for the intensive care unit), precluded meta-analysis.Conclusion:The available literature demonstrates that cerebral perfusion disturbances may be associated with delirium in sepsis. However, future investigations will require consistent definitions of delirium, delirium assessment training, harmonized NIRS and TCD assessments (e.g., consistent measurement site and length of recording), as well as the quantification of secondary and tertiary variables (i.e., Cox, Mxa, MAPOPT), in order to fully assess the relationship between cerebral perfusion and delirium in patients with sepsis.

Highlights

Several studies have previously reported the presence of altered cerebral perfusion during sepsis
We aimed to review the clinical literature on the utilization of near-infrared spectroscopy (NIRS) and/or transcranial Doppler (TCD) as noninvasive surrogates of cerebral perfusion in intensive care unit (ICU) sepsis patients with and without delirium
We aimed to report NIRS and TCD secondary/tertiary derived variables to investigate potential processes associated with poor cerebral perfusion during delirium

Summary

Introduction

Several studies have previously reported the presence of altered cerebral perfusion during sepsis. Sepsis, which occurs when the body’s response to infection results in the dysfunction of one or more organ systems, is a frequent condition in the intensive care unit (ICU) with approximately 30% of all ICU patients either being admitted for or developing sepsis.[1] sepsis is the most common cause of death in hospital.[2] Delirium, a neuropsychiatric syndrome characterized by fluctuating changes in mental status, inattention, altered levels of consciousness, and/or disorganized thinking,[3] affects up to 80% of ICU patients[4] and is believed to share many similar pathophysiological mechanisms with sepsis (e.g., inflammation, microvascular damage, and impaired oxidative metabolism).[4,5,6,7,8] Recently, cerebral oxygenation has been shown to be significantly lower in septic shock patients with delirium,[9] suggesting that poor cerebral perfusion may contribute to the delirium development. It has not been feasible to non-invasively quantify surrogate markers of cerebral perfusion in ICU patients

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