Transcranial Doppler and systemic hemodynamic studies in septic shock

Straver, J. S.; Keunen, R. W. M.; Stam, Cornelis J.; Tavy, D.L.J.; Ruiter, Gerrina; Smith, Steven J.; Thijs, L. G.

doi:10.1080/01616412.1996.11740427

Cited by 14 publications

(12 citation statements)

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“…Straver et al (Straver et al, 1996) also used TCD to evaluate cerebral and systemic hemodynamics in patients with septic shock. The study showed cerebral mean and enddiastolic blood flow significantly enhanced if the systemic vascular resistance index decreased.…”

Section: Discussionmentioning

confidence: 99%

“…Septic encephalopathy has an incidence of up to 70% during sepsis and septic shock (Sprung et al, 1990, Young et al, 1990. The etiology of septic brain dysfunction is not well understood (Straver et al, 1996). Alterations in the release of toxic agents and endotoxins (Ghosh et al, 1993, Hasselgren et al, 1986, the blood-brain barrier (Hasselgren et al, 1986, Jeppsson et al, 1981, the local brain glucose metabolism (Soejima et al, 1990), the content of amino acids and neurotransmitters (Freund et al, 1986), and up-or down regulated gene and protein expression (Chinnaiyan *Address Correspondence to this author at the University Clinic for Anesthesiology and Intensive Care Medicine, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; Tel: ++49.621.383.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally altered mean cerebral blood flow of the whole brain (CBF) and/or local cerebral blood flow (LCBF) have been suggested to be responsible for cerebral dysfunction (Bowie et al, 2003, Hotchkiss et al, 1993, Law et al, 1987, Parker et al, 1983, Straver et al, 1996. Because of the heterogeneous structure of the brain such alterations may affect various parts of the brain to a different extent.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, TCD changes may not reflect the severity of sepsis because they are associated with a number of hemodynamic and rheological factors which all can change cerebral blood flow velocity (e.g. hematocrit, systemic vascular resistance) (Straver et al, 1996).…”

Section: Introductionmentioning

confidence: 99%

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Local Cerebral Blood Flow is Preserved in Sepsis

Hinkelbein¹,

Schroeck²,

Peterka³

et al. 2007

CNR

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Sepsis is often complicated by encephalopathy, neuroendocrine dysfunction and cardiovascular autonomic failure. The cause of septic brain dysfunction is not fully understood. The aim of the present study is to explore whether septic brain dysfunction in a common septic model in the rat correlates with abnormalities either of local cerebral blood flow (LCBF) of defined brain areas or of whole brain blood flow (CBF). 45 male Wistar rats (320+/-13 g) were randomly assigned to a sepsis group (31 rats, cecal ligature and puncture, CLP) or a control group (14 rats, sham operation). Of these 45 rats, 16 rats were used for blood analysis; the remaining 29 rats were used for CBF/LCBF measurements. LCBF measurements were performed 24h after initial surgery using quantitative autoradiography with 4-iodo[N-methyl-(14)C]antipyrine, which allows to analyze CBF on a regional/local and global basis. In 42 different brain regions bilateral optical density measurements were performed. Septic rats (vs. control) presented tachycardia (507+/-37 vs. 452+/-44 min(-1), P<0.05), leukocytopenia (2.96+/-2.37 vs. 8.83+/-2.9710(9) x L(-1), P<0.05), hypocapnia (29.3+/-4.6 vs. 36.4+/-3.9 mmHg, P<0.05), and higher serum lactate concentrations (5.7+/-3.9 vs. 2.2+/-2.0 mmol x L(-1), P<0.05). LCBF of all 42 areas, as well as, CBF (116+/-59 vs. 115+/-52 m x 100 g(-1)min(-1), n.s.) did not differ. The results showed that severe sepsis (mortality rate of 43 %) did not induce alterations in mean CBF and LCBF. It is concluded that brain dysfunction is not reflected in changes of CBF during severe sepsis.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Local Cerebral Blood Flow is Preserved in Sepsis

Hinkelbein¹,

Schroeck²,

Peterka³

et al. 2007

CNR

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“…47,49 Finally, the Lindegaard ratio (MCA/internal carotid artery [ICA] index) is the MCAv divided by the blood flow velocity in the extracranial ICA and is believed to suggest vasospasm when greater than 1.8. 47,61 …”

Section: Cbf Autoregulationmentioning

confidence: 99%

Cerebral Blood Flow Autoregulation in Sepsis for the Intensivist: Why Its Monitoring May Be the Future of Individualized Care

Goodson

Rosenblatt

Rivera‐Lara

et al. 2016

J Intensive Care Med

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Cerebral blood flow (CBF) autoregulation maintains consistent blood flow across a range of blood pressures (BPs). Sepsis is a common cause of systemic hypotension and cerebral dysfunction. Guidelines for BP management in sepsis are based on historical concepts of CBF autoregulation that have now evolved with the availability of more precise technology for its measurement. In this article, we provide a narrative review of methods of monitoring CBF autoregulation, the cerebral effects of sepsis, and the current knowledge of CBF autoregulation in sepsis. Current guidelines for BP management in sepsis are based on a goal of maintaining mean arterial pressure (MAP) above the lower limit of CBF autoregulation. Bedside tools are now available to monitor CBF autoregulation continuously. These data reveal that individual BP goals determined from CBF autoregulation monitoring are more variable than previously expected. In patients undergoing cardiac surgery with cardiopulmonary bypass, for example, the lower limit of autoregulation varied between a MAP of 40 to 90 mm Hg. Studies of CBF autoregulation in sepsis suggest patients frequently manifest impaired CBF autoregulation, possibly a result of BP below the lower limit of autoregulation, particularly in early sepsis or with sepsis-associated encephalopathy. This suggests that the present consensus guidelines for BP management in sepsis may expose some patients to both cerebral hypoperfusion and cerebral hyperperfusion, potentially resulting in damage to brain parenchyma. The future use of novel techniques to study and clinically monitor CBF autoregulation could provide insight into the cerebral pathophysiology of sepsis and offer more precise treatments that may improve functional and cognitive outcomes for survivors of sepsis.

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The Brain in Sepsis

Philips¹,

Bennett²

The Sepsis Text

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Transcranial Doppler and systemic hemodynamic studies in septic shock

Cited by 14 publications

References 0 publications

Local Cerebral Blood Flow is Preserved in Sepsis

Local Cerebral Blood Flow is Preserved in Sepsis

Cerebral Blood Flow Autoregulation in Sepsis for the Intensivist: Why Its Monitoring May Be the Future of Individualized Care

The Brain in Sepsis

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