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Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis
BACKGROUND: Sepsis-associated brain dysfunction (SABD) is associated with high morbidity and mortality. The pathophysiology of SABD is multifactorial. One hypothesis is that impaired cerebral autoregulation (CAR) may result in brain hypoperfusion and neuronal damage leading to SABD. METHODS: We stud...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280405/ https://www.ncbi.nlm.nih.gov/pubmed/30514349 http://dx.doi.org/10.1186/s13054-018-2258-8 |
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author | Crippa, Ilaria Alice Subirà, Carles Vincent, Jean-Louis Fernandez, Rafael Fernandez Hernandez, Silvia Cano Cavicchi, Federica Zama Creteur, Jacques Taccone, Fabio Silvio |
author_facet | Crippa, Ilaria Alice Subirà, Carles Vincent, Jean-Louis Fernandez, Rafael Fernandez Hernandez, Silvia Cano Cavicchi, Federica Zama Creteur, Jacques Taccone, Fabio Silvio |
author_sort | Crippa, Ilaria Alice |
collection | PubMed |
description | BACKGROUND: Sepsis-associated brain dysfunction (SABD) is associated with high morbidity and mortality. The pathophysiology of SABD is multifactorial. One hypothesis is that impaired cerebral autoregulation (CAR) may result in brain hypoperfusion and neuronal damage leading to SABD. METHODS: We studied 100 adult patients with sepsis (July 2012–March 2017) (age = 62 [52–71] years; Acute Physiology and Chronic Health Evaluation II score on admission = 21 [15–26]). Exclusion criteria were acute or chronic intracranial disease, arrhythmias, extracorporeal membrane oxygenation, and known intra- or extracranial supra-aortic vessel disease. The site of infection was predominantly abdominal (46%) or pulmonary (28%). Transcranial Doppler was performed, insonating the left middle cerebral artery with a 2-MHz probe. Middle cerebral artery blood flow velocity (FV) and arterial blood pressure (ABP) signals were recorded simultaneously; Pearson’s correlation coefficient (mean flow index [Mxa]) between ABP and FV was calculated using MATLAB. Impaired CAR was defined as Mxa > 0.3. RESULTS: Mxa was 0.29 [0.05–0.62]. CAR was impaired in 50 patients (50%). In a multiple linear regression analysis, low mean arterial pressure, history of chronic kidney disease and fungal infection were associated with high Mxa. SABD was diagnosed in 57 patients (57%). In a multivariable analysis, altered cerebral autoregulation, mechanical ventilation and history of vascular disease were independent predictors of SABD. CONCLUSIONS: Cerebral autoregulation was altered in half of the patients with sepsis and was associated with the development of SABD. These findings support the concept that cerebral hypoxia could contribute to the development of SABD. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-018-2258-8) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-6280405 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-62804052018-12-10 Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis Crippa, Ilaria Alice Subirà, Carles Vincent, Jean-Louis Fernandez, Rafael Fernandez Hernandez, Silvia Cano Cavicchi, Federica Zama Creteur, Jacques Taccone, Fabio Silvio Crit Care Research BACKGROUND: Sepsis-associated brain dysfunction (SABD) is associated with high morbidity and mortality. The pathophysiology of SABD is multifactorial. One hypothesis is that impaired cerebral autoregulation (CAR) may result in brain hypoperfusion and neuronal damage leading to SABD. METHODS: We studied 100 adult patients with sepsis (July 2012–March 2017) (age = 62 [52–71] years; Acute Physiology and Chronic Health Evaluation II score on admission = 21 [15–26]). Exclusion criteria were acute or chronic intracranial disease, arrhythmias, extracorporeal membrane oxygenation, and known intra- or extracranial supra-aortic vessel disease. The site of infection was predominantly abdominal (46%) or pulmonary (28%). Transcranial Doppler was performed, insonating the left middle cerebral artery with a 2-MHz probe. Middle cerebral artery blood flow velocity (FV) and arterial blood pressure (ABP) signals were recorded simultaneously; Pearson’s correlation coefficient (mean flow index [Mxa]) between ABP and FV was calculated using MATLAB. Impaired CAR was defined as Mxa > 0.3. RESULTS: Mxa was 0.29 [0.05–0.62]. CAR was impaired in 50 patients (50%). In a multiple linear regression analysis, low mean arterial pressure, history of chronic kidney disease and fungal infection were associated with high Mxa. SABD was diagnosed in 57 patients (57%). In a multivariable analysis, altered cerebral autoregulation, mechanical ventilation and history of vascular disease were independent predictors of SABD. CONCLUSIONS: Cerebral autoregulation was altered in half of the patients with sepsis and was associated with the development of SABD. These findings support the concept that cerebral hypoxia could contribute to the development of SABD. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13054-018-2258-8) contains supplementary material, which is available to authorized users. BioMed Central 2018-12-04 /pmc/articles/PMC6280405/ /pubmed/30514349 http://dx.doi.org/10.1186/s13054-018-2258-8 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Crippa, Ilaria Alice Subirà, Carles Vincent, Jean-Louis Fernandez, Rafael Fernandez Hernandez, Silvia Cano Cavicchi, Federica Zama Creteur, Jacques Taccone, Fabio Silvio Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
title | Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
title_full | Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
title_fullStr | Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
title_full_unstemmed | Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
title_short | Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
title_sort | impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6280405/ https://www.ncbi.nlm.nih.gov/pubmed/30514349 http://dx.doi.org/10.1186/s13054-018-2258-8 |
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