Transcranial Doppler Can Predict Development and Outcome of Sepsis-Associated Encephalopathy in Pediatrics With Severe Sepsis or Septic Shock

Abstract

Background and Aim: Sepsis is a common cause of pediatric intensive care unit (ICU) admission. Sepsis-associated encephalopathy (SAE) may occur owing to brain dysfunction in those patients and may be related to impaired cerebral microcirculation. Transcranial Doppler (TCD) can be used to detect this impairment. In this study, we aimed to assess the role of TCD in prediction of SAE and mortality in patients with severe sepsis or septic shock admitted to PICU. Patients and Methods: This prospective study included 75 children admitted to PICU owing to severe sepsis or septic shock. Upon admission, all patients were subjected to careful history taking, thorough clinical examination, and standard laboratory workup. Severity of clinical illness was assessed using the Pediatric Risk of Mortality (PRISM) III score. TCD was performed on the first day of admission after the normalization of systolic blood pressure with or without vasopressors. The primary study outcome was differences in the measurement of TCD in SAE, and the secondary outcome was discharge from ICU or mortality. Results: The study comprised 45 children with SAE and 30 age- and sex-matched children without SAE. In this study, SAE patients had significantly higher pulsatility index [PI; median interquartile range (IQR): 1.15 (0.98–1.48) vs. 1.0 (0.95–1.06), p = 0.002] and resistive index [RI; median (IQR): 0.68 (0.61–0.77) vs. 0.62 (0.59–0.64), p = 0.001] than had non-SAE patients. PI and RI showed good performance as predictors of subsequent SAE development [area under the curve (AUC): 0.72 and 0.73, respectively]. Non-survivors in SAE patients had significantly higher PRISM III. Receiver operating characteristic (ROC) curve analysis showed good performance of PI and RI as predictors of mortality at the end of follow-up. Conclusions: In children with SAE, cerebrovascular resistance is high and is associated with increased mortality.

Diagnostics of Central and Autonomic Nervous System Dysfunction in Patients with Sepsis-Associated Encephalopathy

“…The association between severe sepsis and septic shock and increased cerebral vascular resistance as assessed by TCD estimated pulsatility index (PI) and resistance index (RI) was previously reported (PI = systolic velocity-(diastolic velocity/mean velocity); RI = systolic velocity-(diastolic velocity/systolic velocity)) [26]. The study of Algebaly et al, showed that pediatric septic patients with SAE had significantly higher PI and RI than their counterparts without SAE [27].…”

Dilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage

“…Among these, the evaluation of pulsatility index (PI) and noninvasive estimation of intracranial pressure (e-ICP), both derived from flow velocities of major intracranial arteries (particularly the middle cerebral arteries), as well as the analysis of PI and velocity of venous flow of the superior sagittal sinus or straight sinus, have shown encouraging results. [16][17][18] Howev-er, in a study by Robba et al, which compared all these ultrasonographic methods for identifying intracranial hypertension, ONSD measured by ONUS showed the most significant correlation with invasive measurements of ICP. 19 In another study by Robba et al, e-ICP showed the best correlation with invasive ICP instead.…”

Paediatric sepsis-associated encephalopathy (SAE): a comprehensive review

“…A study by Algebaly et al recruited 45 children with SAE and found that PI and RI were significantly higher in SAE patients compared to their counterparts without SAE. Specifically, PI was more negatively correlated to a Full outline of unresponsiveness (FOUR) score with high significance and PI related well with illness severity when assessed by the paediatric risk of mortality assessment III (PRISM III) and hence increasing cerebrovascular resistance (CVR) with subsequent deepening of coma (Algebaly et al 2020). Similar results were also reported in SAE adult patients, where a majority of patients (76%) presented a maximum PI > 1.1, showing a lower GCS at the initiation of sepsis and indicating that a PI cut-off value of > 1.3 could be used in clinical practice as a risk factor for delirium in septic patients (Pierrakos et al 2014).…”