Abstract
BackgroundTranscranial Doppler can detect cerebral perfusion alteration in septic patients. We correlate static Transcranial Doppler findings with clinical signs of sepsis-associated encephalopathy.MethodsForty septic patients were examined with Transcranial Doppler on the first and third day of sepsis diagnosis. The pulsatility index (PI) and cerebral blood flow index (CBFi) were calculated by blood velocity in the middle cerebral artery (cm/sec). Patients underwent a daily cognitive assessment with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) test.ResultsTwenty-one patients (55%) were found to present confusion. The majority of the patients presented a PI > 1.1 (76%). PI on the first day (but not the third day) could predict a positive CAM-ICU test in septic patients (PI cut-off: 1.3, AUC: 0.905, p < 0.01, sensitivity: 95%, specificity: 88%, AUC: 0.618, p = 0.24). Multivariable analysis showed that PI on the first day is related to a positive CAM-ICU test independent of age and APACHE II score (OR: 5.6, 95% CI: 1.1-29, p = 0.03). A decrease of the PI on the third day was observed in the group that presented initially high PI (>1.3) (2.2 ± 0.71 vs. 1.81 ± 0.64; p = 0.02). On the other hand, an increase in PI was observed in the other patients (1.01 ± 0.15 vs. 1.58 ± 0.57; p < 0.01). On only the first day, the mean blood velocity in the middle cerebral artery and CBFi were found to be lower in those patients with a high initial PI (36 ± 21 vs. 62 ± 28 cm/sec; p < 0.01, 328 ± 101 vs. 581 ± 108; p < 0.01, respectively).ConclusionsCerebral perfusion disturbance observed with Transcranial Doppler could explain clinical symptoms of sepsis-associated encephalopathy.
Highlights
Transcranial Doppler can detect cerebral perfusion alteration in septic patients
The most important finding of this study is that pulsatility index (PI) measured within the first 24 hours after sepsis initiation is related to clinical signs of Sepsis-associated encephalopathy (SAE)
The results of our study show that the relation between clinical signs of SAE and cerebral microcirculation is more complicated since we found that only high PI (>1.3) early in the course of sepsis is related to clinical symptoms of SAE
Summary
Transcranial Doppler can detect cerebral perfusion alteration in septic patients. We correlate static Transcranial Doppler findings with clinical signs of sepsis-associated encephalopathy. Sepsis-associated encephalopathy (SAE) is a common complication in critically ill patients and is considered to be an independent prognostic factor for increased mortality [1,2]. Cerebral microcirculation alterations related to sepsis are characterized by a decrease in the density of perfused microvessels [5]. An increase in the distance between neurons and capillaries can possibly cause an inadequate oxygen supply. Given that the brain is highly dependent on an adequate oxygen supply, any deficit can be related to immediate important cerebral dysfunction [6]. A decrease in the density of perfused microvessels can be related to an increase in cerebrovascular resistance.
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