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Transcranial Doppler to assess sepsis-associated encephalopathy in critically ill patients.

Pierrakos C, Attou R, Decorte L, Kolyviras A, Malinverni S, Gottignies P, Devriendt J, De Bels D - BMC Anesthesiol (2014)

Bottom Line: 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).

View Article: PubMed Central - HTML - PubMed

Affiliation: Departments of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Place Van Gehuchten 4, 1020 Bruxelles, Belgium.

ABSTRACT

Background: Transcranial Doppler can detect cerebral perfusion alteration in septic patients. We correlate static Transcranial Doppler findings with clinical signs of sepsis-associated encephalopathy.

Methods: Forty 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.

Results: Twenty-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).

Conclusions: Cerebral perfusion disturbance observed with Transcranial Doppler could explain clinical symptoms of sepsis-associated encephalopathy.

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PI evolution in patients who showed PI > 1.3 on the first day.
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Figure 2: PI evolution in patients who showed PI > 1.3 on the first day.

Mentions: The measurements of VMCA and calculations of PI and CBFi, as well as MAP and pCO2 values at the time of examination, are presented in Tables 3 and 4. Patients with high PI have statistically lower values of mean VMCA and CBFi compared with patients with lower PI (36 ± 21 vs. 62 ± 28 cm/sec, p < 0.01; 328 ± 101 vs. 581 ± 108, p < 0.01), only on the first day. No statistically significant differences for PI were found between groups on the third day (1.81 ± 0.64 vs. 1.58 ± 0.57). The evolution of PI over three days of observation is presented in Figures 2 and 3.


Transcranial Doppler to assess sepsis-associated encephalopathy in critically ill patients.

Pierrakos C, Attou R, Decorte L, Kolyviras A, Malinverni S, Gottignies P, Devriendt J, De Bels D - BMC Anesthesiol (2014)

PI evolution in patients who showed PI > 1.3 on the first day.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4061318&req=5

Figure 2: PI evolution in patients who showed PI > 1.3 on the first day.
Mentions: The measurements of VMCA and calculations of PI and CBFi, as well as MAP and pCO2 values at the time of examination, are presented in Tables 3 and 4. Patients with high PI have statistically lower values of mean VMCA and CBFi compared with patients with lower PI (36 ± 21 vs. 62 ± 28 cm/sec, p < 0.01; 328 ± 101 vs. 581 ± 108, p < 0.01), only on the first day. No statistically significant differences for PI were found between groups on the third day (1.81 ± 0.64 vs. 1.58 ± 0.57). The evolution of PI over three days of observation is presented in Figures 2 and 3.

Bottom Line: 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).

View Article: PubMed Central - HTML - PubMed

Affiliation: Departments of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Place Van Gehuchten 4, 1020 Bruxelles, Belgium.

ABSTRACT

Background: Transcranial Doppler can detect cerebral perfusion alteration in septic patients. We correlate static Transcranial Doppler findings with clinical signs of sepsis-associated encephalopathy.

Methods: Forty 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.

Results: Twenty-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).

Conclusions: Cerebral perfusion disturbance observed with Transcranial Doppler could explain clinical symptoms of sepsis-associated encephalopathy.

Show MeSH
Related in: MedlinePlus