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Ann Intensive Care. 2013 Aug 22;3:28. doi: 10.1186/2110-5820-3-28. eCollection 2013.

Transcranial doppler assessment of cerebral perfusion in critically ill septic patients: a pilot study.

Author information

1
Department of Intensive Care, Université Catholique de Louvain, Mont-Godinne University Hospital, Avenue Docteur G., Thérasse 1, Yvoir 5530, Belgium.
2
Department of Internal Medicine, University Hospital of Patras, Patras Rio 26504, Greece.
3
Department of Neurology, Université Catholique de Louvain, Mont-Godinne University Hospital, Avenue Docteur G., Thérasse 1, Yvoir 5530, Belgium.

Abstract

BACKGROUND:

The aim of this study is to evaluate the feasibility and efficacy of Transcranial Doppler (TCD) in assessing cerebral perfusion changes in septic patients.

METHODS:

Using TCD, we measured the mean velocity in the middle cerebral artery (VmMCA, cm/sec) and calculated the pulsatility index (PI), resistance index (RI) and cerebral blood flow index (CBFi = 10*MAP/1.47(PI)) on the first day of patients' admission or on the first day of sepsis development; measurements were repeated on the second day. Sepsis was defined according to standard criteria.

RESULTS:

Forty-one patients without any known neurologic deficit treated in our 24-bed Critical Care Unit were assessed (Sepsis Group = 20, Control Group = 21). Examination was feasible in 91% of septic and 85% of non-septic patients (p = 0.89). No difference was found between the two groups in mean age, mean arterial pressure (MAP) or APACHE II score. The pCO2 values were higher in septic patients (46 ± 12 vs. 39 ± 4 mmHg p < 0.01). No statistically significant higher values of VmMCA were found in septic patients (110 ± 34 cm/sec vs. 99 ± 28 cm/sec p = 0.17). Higher values of PI and RI were found in septic patients (1.15 ± 0.25 vs. 0.98 ± 0.16 p < 0.01, 0.64 ± 0.08 vs. 0.59 ± 0.06 p < 0.01, respectively). No statistically significant lower values of CBFi were found in septic patients (497 ± 116 vs. 548 ± 110 p = 0.06).

CONCLUSIONS:

Our results suggest cerebral vasoconstriction in septic compared to non-septic patients. TCD is an efficient and feasible exam to evaluate changes in cerebral perfusion during sepsis.

KEYWORDS:

Cerebral microcirculation; Cerebral vasoconstriction; Encephalopathy; Pulsatility index; Resistance index; Sepsis

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