Impaired cerebral autoregulation is associated with brain dysfunction in patients with sepsis

Ilaria Alice Crippa, Carles Subirà, Jean-Louis Vincent, Rafael Fernandez Fernandez, Silvia Cano Hernandez, Federica Zama Cavicchi, Jacques Creteur, Fabio Silvio Taccone, Ilaria Alice Crippa, Carles Subirà, Jean-Louis Vincent, Rafael Fernandez Fernandez, Silvia Cano Hernandez, Federica Zama Cavicchi, Jacques Creteur, Fabio Silvio Taccone

Abstract

Background: Sepsis-associated brain dysfunction (SABD) is associated with high morbidity and mortality. The pathophysiology of SABD is multifactorial. One hypothesis is that impaired cerebral autoregulation (CAR) may result in brain hypoperfusion and neuronal damage leading to SABD.

Methods: We studied 100 adult patients with sepsis (July 2012-March 2017) (age = 62 [52-71] years; Acute Physiology and Chronic Health Evaluation II score on admission = 21 [15-26]). Exclusion criteria were acute or chronic intracranial disease, arrhythmias, extracorporeal membrane oxygenation, and known intra- or extracranial supra-aortic vessel disease. The site of infection was predominantly abdominal (46%) or pulmonary (28%). Transcranial Doppler was performed, insonating the left middle cerebral artery with a 2-MHz probe. Middle cerebral artery blood flow velocity (FV) and arterial blood pressure (ABP) signals were recorded simultaneously; Pearson's correlation coefficient (mean flow index [Mxa]) between ABP and FV was calculated using MATLAB. Impaired CAR was defined as Mxa > 0.3.

Results: Mxa was 0.29 [0.05-0.62]. CAR was impaired in 50 patients (50%). In a multiple linear regression analysis, low mean arterial pressure, history of chronic kidney disease and fungal infection were associated with high Mxa. SABD was diagnosed in 57 patients (57%). In a multivariable analysis, altered cerebral autoregulation, mechanical ventilation and history of vascular disease were independent predictors of SABD.

Conclusions: Cerebral autoregulation was altered in half of the patients with sepsis and was associated with the development of SABD. These findings support the concept that cerebral hypoxia could contribute to the development of SABD.

Keywords: Brain dysfunction; Cerebral blood flow; Cerebrovascular circulation; Doppler sonography; Transcranial.

Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by local ethics committees, and informed consent was obtained from the patients or their legal representatives.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Correlation between mean flow index and mean arterial blood pressure
Fig. 2
Fig. 2
Mean flow index (Mxa) in patients with and without sepsis-associated encephalopathy (sepsis-associated brain dysfunction [SABD]). Mxa is higher in patients with SABD (0.37 ± 0.05 vs 0.18 ± 0.06; p = 0.03)

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