Microcirculatory dysfunction precedes changes in evoked potentials in endotoxin-induced sepsis syndrome in rats

Rosengarten, Bernhard; Hecht, Mirko; Auch, D.; Ghofrani, HA; Schermuly, Ralph T.; Grimminger, Friedrich; Kaps, Manfred

doi:10.1055/s-2006-939267

Cited by 5 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Animal experiments suggested that early detection of SAE can be achieved by the neurobiology score, EEG monitoring, and somatosensory-evoked potential monitoring. [17][18][19] Another study also emphasized the importance of discovering SAE early by assessing the cerebral blood flow velocity and monitoring the changes in the brain electrical activity. 7,20 The transcranial Doppler (TCD) can be noninvasive, bedside, continuous, real-time monitor of the cerebral blood flow status, especially in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%

Characterization of Sepsis and Sepsis-Associated Encephalopathy

Feng

Gong

et al. 2017

J Intensive Care Med

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Characterization of Sepsis and Sepsis-Associated Encephalopathy

Feng

Gong

et al. 2017

J Intensive Care Med

View full text Add to dashboard Cite

show abstract

“…20 In septic patients with delirium, impaired cerebrovascular autoregulation has been observed. 18,19,43 Additionally, animal models of sepsis-associated delirium have demonstrated neurovascular uncoupling, 44 early vasogenic oedema around the circle of Willis corresponding to bloodbrain barrier disruption, 45 and reduced glucose uptake in neocortical areas 46 after lipopolysaccharide administration. While approximately two-thirds of our patients suffered from sepsis, others lacked an infective source, suggesting that in our sample, metabolic impairments may be attributable to a variety of insults and possible mechanisms.…”

Section: Discussionmentioning

confidence: 99%

2-¹⁸F-fluoro-2-deoxyglucose positron emission tomography in delirium

Haggstrom

Nelson

Wegner

et al. 2017

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

Delirium is a common, serious, yet poorly understood syndrome. Growing evidence suggests cerebral metabolism is fundamentally disturbed; however, it has not been investigated using 2-F-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) in delirium. This prospective study thus explored FDG PET patterns of cerebral glucose metabolism in older inpatients with delirium. A particular emphasis was on the posterior cingulate cortex (PCC), a key region for attention, which is a central feature of delirium. Delirium scans were compared with post-delirium scans using visual analysis and semi-quantitative analysis with NeuroQ; 13 participants (8 female, median 84 y) were scanned during delirium, and 6 scanned again after resolution. On visual analysis, cortical hypometabolism was evident in all participants during delirium (13/13), and improved with delirium resolution (6/6). Using NeuroQ, glucose metabolism was higher post-delirium in the whole brain and bilateral PCC compared to during delirium ( p < 0.05). Greater metabolism in both PCCs correlated with better performance on a neuropsychological test of attention, the WAIS-IV Digit Span Test forwards, and with shorter delirium duration. This research found widespread, reversible cortical hypometabolism during delirium and PCC hypometabolism was associated with inattention during delirium.

show abstract

“…7,45,46 Based on the results of our small study, the effect of these mechanisms on cerebral autoregulation and brain perfusion may be substantial. 5,47…”

Section: Discussionmentioning

confidence: 99%

Cerebral Autoregulation–Guided Optimal Blood Pressure in Sepsis-Associated Encephalopathy: A Case Series

Rosenblatt

Walker

Goodson

et al. 2019

J Intensive Care Med

View full text Add to dashboard Cite

Background: Impaired cerebral autoregulation and cerebral hypoperfusion may play a critical role in the high morbidity and mortality in patients with sepsis-associated encephalopathy (SAE). Bedside assessment of cerebral autoregulation may help individualize hemodynamic targets that optimize brain perfusion. We hypothesize that near-infrared spectroscopy (NIRS)–derived cerebral oximetry can identify blood pressure ranges that enhance autoregulation in patients with SAE and that disturbances in autoregulation are associated with severity of encephalopathy. Methods: Adult patients with acute encephalopathy directly attributable to sepsis were followed using NIRS-based multimodal monitoring for 12 consecutive hours. We used the correlation in time between regional cerebral oxygen saturation and mean arterial pressure (MAP) to determine the cerebral oximetry index (COx) as a measure of cerebral autoregulation. Autoregulation curves were constructed for each patient with averaged COx values sorted by MAP in 3 sequential 4-hour periods; the optimal pressure (MAPOPT), defined as the MAP associated with most robust autoregulation (lowest COx), was identified in each period. Severity of encephalopathy was measured with Glasgow coma scale (GCS). Results: Six patients with extracranial sepsis met the stringent criteria specified, including no pharmacological sedation or neurologic premorbidity. Optimal MAP was identified in all patients and ranged from 55 to 115 mmHg. Additionally, MAPOPT varied within individual patients over time during monitoring. Disturbed autoregulation, based on COx, was associated with worse neurologic status (GCS < 13) both with and without controlling for age and severity of sepsis (adjusted odds ratio [OR]: 2.11; 95% confidence interval [CI]: 1.77-2.52; P < .001; OR: 2.97; 95% CI: 1.63-5.43; P < .001). Conclusions: In this high-fidelity group of patients with SAE, continuous, NIRS-based monitoring can identify blood pressure ranges that improve autoregulation. This is important given the association between cerebral autoregulatory function and severity of encephalopathy. Individualizing blood pressure goals using bedside autoregulation monitoring may better preserve cerebral perfusion in SAE than current practice.

show abstract

Microcirculatory dysfunction precedes changes in evoked potentials in endotoxin-induced sepsis syndrome in rats

Cited by 5 publications

References 0 publications

Characterization of Sepsis and Sepsis-Associated Encephalopathy

Characterization of Sepsis and Sepsis-Associated Encephalopathy

2-¹⁸F-fluoro-2-deoxyglucose positron emission tomography in delirium

Cerebral Autoregulation–Guided Optimal Blood Pressure in Sepsis-Associated Encephalopathy: A Case Series

Contact Info

Product

Resources

About

Microcirculatory dysfunction precedes changes in evoked potentials in endotoxin-induced sepsis syndrome in rats

Cited by 5 publications

References 0 publications

Characterization of Sepsis and Sepsis-Associated Encephalopathy

Characterization of Sepsis and Sepsis-Associated Encephalopathy

2-18F-fluoro-2-deoxyglucose positron emission tomography in delirium

Cerebral Autoregulation–Guided Optimal Blood Pressure in Sepsis-Associated Encephalopathy: A Case Series

Contact Info

Product

Resources

About

2-¹⁸F-fluoro-2-deoxyglucose positron emission tomography in delirium