Encefalopatia septyczna a majaczenie stanu ciężkiego

Abstract

Introduction: Sepsis-associated encephalopathy is an acute dysfunction of the central nervous system (CNS) that arises as a consequence of generalized systemic infection, yet without brain infection. The aim of this review is to introduce septic encephalopathy as a disease, with all of the epidemiology data, diagnostic opportunities, pathophysiology and possible treatment. Sepsis-associated encephalopathy is a medical condition characterized by a broad spectrum of disturbances of consciousness, from delirium to coma, with possible seizures or focal neurological signs. Many pathophysiological mechanisms lie at the basis of septic encephalopathy, including inflammation or dysfunction of cerebral perfusion. Another important mechanism includes interactions between inflammatory cytokines and acetylcholine that lead to abnormal cholinergic transmission and neuronal death. Moreover, interaction between acetylcholine and inflammatory cytokines may induce immunosuppression. Sepsis-associated encephalopathy diagnosis is strictly clinical, based on neurological examination and the exclusion of other causes, because there are no definite biochemical tests or radiological studies specific for this disease. The use of ICU delirium screening tools, such as CAM-ICU (Confusion Assessment Method for the Intensive Care Unit) enables earlier detection of brain dysfunction. Neuroimaging studies (computed tomography, magnetic resonance imaging), as well as electroencephalograhy may be helpful in the assessment of the severity of dysfunction. The most important element is early diagnosis of sepsis, especially with the use of the QuickSOFA scale, and early initiation of multidirectional treatment according to Surviving Sepsis Campaign guidelines: early source identification and source control, initiation of optimal antibiotic therapy, adequate fluid therapy and supportive treatment for major organs. In order to prevent CNS dysfunction in the ICU, deep sedation and benzodiazepines should be avoided and dexmedetomidine and propofol introduced instead. Pharmacological treatment of ICU delirium is based on the use of typical (haloperidol) and atypical (i.e. quetiapine) antipsychotics. Non-pharmacological methods include early mobilization, ensuring day and night cycles, the minimalization of noctural factors (light, sounds, interventions), and family engagement. Conclusion: Sepsis-associated encephalopathy is a serious illness associated with severe consequences, including increased mortality, long-term cognitive dysfunction, and immunosuppression. The co-dependence between septic encephalopathy and the immune system should be underlined in the approach towards sepsis treatment. Keywords: sepsis associated encephalopathy; sepsis; ICU delirium; CAM-ICU; cognitive dysfunction. ABSTRAKT Wstęp:Encefalopatia septyczna (sepsis-associated encephalopathy -SAE) jest ostrym zaburzeniem funkcjonowania ośrodko-wego układu nerwowego (OUN), które pojawia się w następstwie infekcji ogólnoustrojowej, jednak bez infekcji samego mózgu. Celem ninie...