Early Evidence of Sepsis-Associated Hyperperfusion—A Study of Cerebral Blood Flow Measured With MRI Arterial Spin Labeling in Critically Ill Septic Patients and Control Subjects*

Masse, Marie-Hélène; Richard, Marie Anne; D’Aragon, Frédérick; St-Arnaud, Charles; Mayette, Michaël; Adhikari, Neill K. J.; Fraser, William D.; Carpentier, André C.; Palanchuck, Steven; Gauthier, David A.; Lanthier, Luc; Touchette, Matthieu; Lamontagne, Albert; Chénard, Jean; Mehta, Sangeeta; Sansoucy, Yanick; Croteau, Étienne; Lepage, Martin; Lamontagne, François

doi:10.1097/ccm.0000000000003147

Cited by 16 publications

(10 citation statements)

References 26 publications

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“…32 In contrast, a recent pilot study using arterial spin labeling magnetic resonance imaging demonstrated increased cerebral blood flow in patients with delirium compared to controls. 27 Clearly, the alterations in cerebral blood flow and perfusion during delirium warrant further investigation.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between Near-Infrared Spectroscopy-Derived Cerebral Oxygenation and Delirium in Critically Ill Patients: A Systematic Review

Bendahan

Neal

Ross‐White

et al. 2018

J Intensive Care Med

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Background: A common neurological complication of critical illness is delirium, defined as an acute change in level of consciousness, with impaired attention and disorganized thinking. Patients with delirium have increased risk of long-term cognitive dysfunction and mortality. The cause is unknown, which limits our ability to design therapeutic interventions. In patients undergoing surgery, low regional cerebral oxygenation (rSO2), as measured by near-infrared spectroscopy (NIRS), is associated with postoperative neurological dysfunction (eg delirium and long-term cognitive impairment). However, the relationship between NIRSderived rSO2 and neurological outcomes in critically ill patients is unclear. The objective of this study was to assess the utilization of NIRS-derived rSO2 in critically ill patients outside the operating theater. We aimed to examine the relationship between rSO2 and neurological outcomes as well as to report rSO2 values in this population. Methods: The following databases were searched from inception to August 14, 2017: Ovid MedLine, Embase, Cochrane Library, and Web of Science. Results: Of 1410 articles identified by the search strategy, 8 were ultimately selected for final review. Most (7 of 8) were published since 2014. These studies included a total of 213 patients primarily with shock or respiratory failure. A variety of devices were used to measure rSO2, including INVOS and FORESIGHT. The duration of recording varied from 5 minutes to 72 hours. Four of the 8 studies reported on neurological outcomes. In all 4 studies, rSO2 was lower in critically ill patients who were delirious compared to controls, but this was only statistically significant in 2 of the studies. The heterogeneity in devices and duration of recording precluded meta-analysis. Conclusions: There is limited literature describing rSO2 in critically ill patients outside the operating room. Although there may be a slight signal of an association between low rSO2 and delirium, more study is needed to explore this relationship.

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Section: Discussionmentioning

confidence: 99%

Relationship Between Near-Infrared Spectroscopy-Derived Cerebral Oxygenation and Delirium in Critically Ill Patients: A Systematic Review

Bendahan

Neal

Ross‐White

et al. 2018

J Intensive Care Med

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“…This is the first study to demonstrate compromised NVC responses in a relevant preclinical animal model of geriatric sepsis. Previous clinical studies reported multifaceted effects of sepsis on cerebral blood flow regulation (Terborg et al, 2001;Bowie et al, 2003;Pfister et al, 2008;Toksvang et al, 2014;Vasko et al, 2014;de Azevedo et al, 2017;Crippa et al, 2018;Masse et al, 2018). The emerging concept is that both reduced cerebral blood flow and altered autoregulation contribute to sepsis-associated encephalopathy.…”

Section: Discussionmentioning

confidence: 99%

Endothelial Dysfunction and Impaired Neurovascular Coupling Responses Precede Cognitive Impairment in a Mouse Model of Geriatric Sepsis

Csípő

Cassidy

Balasubramanian

et al. 2021

Front. Aging Neurosci.

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Sepsis is a life-threatening condition, the incidence of which is significantly increased in elderly patients. One of the long-lasting effects of sepsis is cognitive impairment defined as a new deficit or exacerbation of preexisting deficits in global cognition or executive function. Normal brain function is dependent on moment-to-moment adjustment of cerebral blood flow to match the increased demands of active brain regions. This homeostatic mechanism, termed neurovascular coupling (NVC, also known as functional hyperemia), is critically dependent on the production of vasodilator NO by microvascular endothelial cells in response to mediators released from activated astrocytes. The goal of this study was to test the hypothesis that sepsis in aging leads to impairment of NVC responses early after treatment and that this neurovascular dysfunction associates with impairments in cognitive performance and vascular endothelial dysfunction. To test this hypothesis, we used a commonly studied bacterial pathogen, Listeria monocytogenes, to induce sepsis in experimental animals (males, 24 months of age) and subjected experimental animals to a standard clinical protocol of 3 doses of ampicillin i.p. and 14 days of amoxicillin added to the drinking water. NVC responses, endothelial function and cognitive performance were measured in septic and age-matched control groups within 14 days after the final antibiotic treatment. Our data demonstrate that sepsis in aging significantly impairs NVC responses measured in somatosensory cortex during whisker stimulation, significantly impairs endothelial function in isolated and pressure cannulated aorta rings in response to acetylcholine stimulation. No significant impairment of cognitive function in post-sepsis aged animals has been observed when measured using the PhenoTyper homecage based system. Our findings suggest that sepsis-associated endothelial dysfunction and impairment of NVC responses may contribute to long-term cognitive deficits in older sepsis survivors.

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“…Cerebral blood flow (CBF) autoregulation can maintain consistent CBF within a certain blood pressure range, and patients with sepsis usually have damaged CBF autoregulation[ 22 ]. Masse et al [ 23 ] showed that CBF in sedated septic patients was 62% higher than that in control subjects and did not change with mean arterial pressure. The relationship between inflammation and cerebral hyperperfusion needs to be further studied[ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Masse et al [ 23 ] showed that CBF in sedated septic patients was 62% higher than that in control subjects and did not change with mean arterial pressure. The relationship between inflammation and cerebral hyperperfusion needs to be further studied[ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Association between neutrophil-to-lymphocyte ratio and major postoperative complications after carotid endarterectomy: A retrospective cohort study

Yu¹,

Cui²,

Cheng³

et al. 2021

WJCC

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BACKGROUND Carotid artery cross-clamping during carotid endarterectomy (CEA) may damage local cerebral perfusion and induce cerebral ischemia–reperfusion injury to activate local inflammatory responses. Neutrophil-to-lymphocyte ratio (NLR) is an indicator that reflects systemic inflammation. However, the correlation between NLR and complications after CEA remains unclear. AIM To investigate the association between NLR and major complications after surgery in patients undergoing CEA. METHODS This retrospective cohort study included patients who received CEA between January 2016 and July 2018 at Beijing Tiantan Hospital. Neutrophil and lymphocyte counts in whole blood within 24 h after CEA were collected. The primary outcome was the composite of major postoperative complications including neurological, pulmonary, cardiovascular and acute kidney injuries. The secondary outcomes included infections, fever, deep venous thrombosis, length of hospitalization and cost of hospitalization. Statistical analyses were performed using EmpowerStats software and R software. RESULTS A total of 224 patients who received CEA were screened for review and 206 were included in the statistical analyses; of whom, 40 (19.42%) developed major postoperative complications. NLR within 24 h after CEA was significantly correlated with major postoperative complications ( P = 0.026). After confounding factors were adjusted, the odds ratio was 1.15 (95%CI: 1.03–1.29, P = 0.014). The incidence of major postoperative complications in the high NLR group was 8.47 times that in the low NLR group ( P = 0.002). CONCLUSION NLR is associated with major postoperative complications in patients undergoing CEA.

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Early Evidence of Sepsis-Associated Hyperperfusion—A Study of Cerebral Blood Flow Measured With MRI Arterial Spin Labeling in Critically Ill Septic Patients and Control Subjects*

Cited by 16 publications

References 26 publications

Relationship Between Near-Infrared Spectroscopy-Derived Cerebral Oxygenation and Delirium in Critically Ill Patients: A Systematic Review

Relationship Between Near-Infrared Spectroscopy-Derived Cerebral Oxygenation and Delirium in Critically Ill Patients: A Systematic Review

Endothelial Dysfunction and Impaired Neurovascular Coupling Responses Precede Cognitive Impairment in a Mouse Model of Geriatric Sepsis

Association between neutrophil-to-lymphocyte ratio and major postoperative complications after carotid endarterectomy: A retrospective cohort study

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