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Abstract
BackgroundThe aim of this study is to evaluate the feasibility and efficacy of Transcranial Doppler (TCD) in assessing cerebral perfusion changes in septic patients.MethodsUsing TCD, we measured the mean velocity in the middle cerebral artery (VmMCA, cm/sec) and calculated the pulsatility index (PI), resistance index (RI) and cerebral blood flow index (CBFi = 10*MAP/1.47PI) on the first day of patients’ admission or on the first day of sepsis development; measurements were repeated on the second day. Sepsis was defined according to standard criteria.ResultsForty-one patients without any known neurologic deficit treated in our 24-bed Critical Care Unit were assessed (Sepsis Group = 20, Control Group = 21). Examination was feasible in 91% of septic and 85% of non-septic patients (p = 0.89). No difference was found between the two groups in mean age, mean arterial pressure (MAP) or APACHE II score. The pCO2 values were higher in septic patients (46 ± 12 vs. 39 ± 4 mmHg p < 0.01). No statistically significant higher values of VmMCA were found in septic patients (110 ± 34 cm/sec vs. 99 ± 28 cm/sec p = 0.17). Higher values of PI and RI were found in septic patients (1.15 ± 0.25 vs. 0.98 ± 0.16 p < 0.01, 0.64 ± 0.08 vs. 0.59 ± 0.06 p < 0.01, respectively). No statistically significant lower values of CBFi were found in septic patients (497 ± 116 vs. 548 ± 110 p = 0.06).ConclusionsOur results suggest cerebral vasoconstriction in septic compared to non-septic patients. TCD is an efficient and feasible exam to evaluate changes in cerebral perfusion during sepsis.
Highlights
The aim of this study is to evaluate the feasibility and efficacy of Transcranial Doppler (TCD) in assessing cerebral perfusion changes in septic patients
Exclusion criteria for both groups were as follows: 1) age < 18 years old, 2) known cerebral lesion, 3) cerebral infection, 4) encephalopathy associated with hyperuremia, hypernatremia or hypoglycaemia, 5) hepatic encephalopathy, 6) patient supported by Intra-Aortic Balloon Pump or Sepsis group Control group p values
Based on this formula, and given that cerebral blood flow (CBF) is estimated by the formula Perfusion Pressure/cerebrovascular resistances, we considered pulsatility index (PI) relate to cerebral resistances (CBVR) : CBVR ≈ 1.47PI/10
Summary
The aim of this study is to evaluate the feasibility and efficacy of Transcranial Doppler (TCD) in assessing cerebral perfusion changes in septic patients. Sepsis-associated encephalopathy (SAE) may develop in more than 50% of septic patients [1,2]. It is one of the most common causes of delirium in intensive care units [3], where it is an independent prognostic factor for increased mortality [4]. Alterations in cerebral perfusion during sepsis possibly play an important response to several stimulations with TCD has been previously performed [12,13,14,15,16,17]. The aim of this study is to assess static cerebral perfusion characteristics and changes in septic versus non-septic critically ill patients
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