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Cerebral perfusion in sepsis-associated delirium

INTRODUCTION: The pathophysiology of sepsis-associated delirium is not completely understood and the data on cerebral perfusion in sepsis are conflicting. We tested the hypothesis that cerebral perfusion and selected serum markers of inflammation and delirium differ in septic patients with and witho...

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Autores principales: Pfister, David, Siegemund, Martin, Dell-Kuster, Salome, Smielewski, Peter, Rüegg, Stephan, Strebel, Stephan P, Marsch, Stephan CU, Pargger, Hans, Steiner, Luzius A
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2008
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2481444/
https://www.ncbi.nlm.nih.gov/pubmed/18457586
http://dx.doi.org/10.1186/cc6891
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author Pfister, David
Siegemund, Martin
Dell-Kuster, Salome
Smielewski, Peter
Rüegg, Stephan
Strebel, Stephan P
Marsch, Stephan CU
Pargger, Hans
Steiner, Luzius A
author_facet Pfister, David
Siegemund, Martin
Dell-Kuster, Salome
Smielewski, Peter
Rüegg, Stephan
Strebel, Stephan P
Marsch, Stephan CU
Pargger, Hans
Steiner, Luzius A
author_sort Pfister, David
collection PubMed
description INTRODUCTION: The pathophysiology of sepsis-associated delirium is not completely understood and the data on cerebral perfusion in sepsis are conflicting. We tested the hypothesis that cerebral perfusion and selected serum markers of inflammation and delirium differ in septic patients with and without sepsis-associated delirium. METHODS: We investigated 23 adult patients with sepsis, severe sepsis, or septic shock with an extracranial focus of infection and no history of intracranial pathology. Patients were investigated after stabilisation within 48 hours after admission to the intensive care unit. Sepsis-associated delirium was diagnosed using the confusion assessment method for the intensive care unit. Mean arterial pressure (MAP), blood flow velocity (FV) in the middle cerebral artery using transcranial Doppler, and cerebral tissue oxygenation using near-infrared spectroscopy were monitored for 1 hour. An index of cerebrovascular autoregulation was calculated from MAP and FV data. C-reactive protein (CRP), interleukin-6 (IL-6), S-100β, and cortisol were measured during each data acquisition. RESULTS: Data from 16 patients, of whom 12 had sepsis-associated delirium, were analysed. There were no significant correlations or associations between MAP, cerebral blood FV, or tissue oxygenation and sepsis-associated delirium. However, we found a significant association between sepsis-associated delirium and disturbed autoregulation (P = 0.015). IL-6 did not differ between patients with and without sepsis-associated delirium, but we found a significant association between elevated CRP (P = 0.008), S-100β (P = 0.029), and cortisol (P = 0.011) and sepsis-associated delirium. Elevated CRP was significantly correlated with disturbed autoregulation (Spearman rho = 0.62, P = 0.010). CONCLUSION: In this small group of patients, cerebral perfusion assessed with transcranial Doppler and near-infrared spectroscopy did not differ between patients with and without sepsis-associated delirium. However, the state of autoregulation differed between the two groups. This may be due to inflammation impeding cerebrovascular endothelial function. Further investigations defining the role of S-100β and cortisol in the diagnosis of sepsis-associated delirium are warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT00410111.
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spelling pubmed-24814442008-07-24 Cerebral perfusion in sepsis-associated delirium Pfister, David Siegemund, Martin Dell-Kuster, Salome Smielewski, Peter Rüegg, Stephan Strebel, Stephan P Marsch, Stephan CU Pargger, Hans Steiner, Luzius A Crit Care Research INTRODUCTION: The pathophysiology of sepsis-associated delirium is not completely understood and the data on cerebral perfusion in sepsis are conflicting. We tested the hypothesis that cerebral perfusion and selected serum markers of inflammation and delirium differ in septic patients with and without sepsis-associated delirium. METHODS: We investigated 23 adult patients with sepsis, severe sepsis, or septic shock with an extracranial focus of infection and no history of intracranial pathology. Patients were investigated after stabilisation within 48 hours after admission to the intensive care unit. Sepsis-associated delirium was diagnosed using the confusion assessment method for the intensive care unit. Mean arterial pressure (MAP), blood flow velocity (FV) in the middle cerebral artery using transcranial Doppler, and cerebral tissue oxygenation using near-infrared spectroscopy were monitored for 1 hour. An index of cerebrovascular autoregulation was calculated from MAP and FV data. C-reactive protein (CRP), interleukin-6 (IL-6), S-100β, and cortisol were measured during each data acquisition. RESULTS: Data from 16 patients, of whom 12 had sepsis-associated delirium, were analysed. There were no significant correlations or associations between MAP, cerebral blood FV, or tissue oxygenation and sepsis-associated delirium. However, we found a significant association between sepsis-associated delirium and disturbed autoregulation (P = 0.015). IL-6 did not differ between patients with and without sepsis-associated delirium, but we found a significant association between elevated CRP (P = 0.008), S-100β (P = 0.029), and cortisol (P = 0.011) and sepsis-associated delirium. Elevated CRP was significantly correlated with disturbed autoregulation (Spearman rho = 0.62, P = 0.010). CONCLUSION: In this small group of patients, cerebral perfusion assessed with transcranial Doppler and near-infrared spectroscopy did not differ between patients with and without sepsis-associated delirium. However, the state of autoregulation differed between the two groups. This may be due to inflammation impeding cerebrovascular endothelial function. Further investigations defining the role of S-100β and cortisol in the diagnosis of sepsis-associated delirium are warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT00410111. BioMed Central 2008 2008-05-05 /pmc/articles/PMC2481444/ /pubmed/18457586 http://dx.doi.org/10.1186/cc6891 Text en Copyright © 2008 Pfister et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Pfister, David
Siegemund, Martin
Dell-Kuster, Salome
Smielewski, Peter
Rüegg, Stephan
Strebel, Stephan P
Marsch, Stephan CU
Pargger, Hans
Steiner, Luzius A
Cerebral perfusion in sepsis-associated delirium
title Cerebral perfusion in sepsis-associated delirium
title_full Cerebral perfusion in sepsis-associated delirium
title_fullStr Cerebral perfusion in sepsis-associated delirium
title_full_unstemmed Cerebral perfusion in sepsis-associated delirium
title_short Cerebral perfusion in sepsis-associated delirium
title_sort cerebral perfusion in sepsis-associated delirium
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2481444/
https://www.ncbi.nlm.nih.gov/pubmed/18457586
http://dx.doi.org/10.1186/cc6891
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