How to monitor the brain in septic patients?

Détails

ID Serval
serval:BIB_8FB6DCB3431A
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
How to monitor the brain in septic patients?
Périodique
Minerva Anestesiologica
Auteur(s)
Oddo M., Taccone F.S.
ISSN
1827-1596 (Electronic)
ISSN-L
0375-9393
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
81
Numéro
7
Pages
776-788
Langue
anglais
Notes
Publication types: Journal ArticlePublication Status: ppublish
Résumé
Brain injury is frequently observed after sepsis and may be primarily related to the direct effects of the septic insult on the brain (e.g., brain edema, ischemia, seizures) or to secondary/indirect injuries (e.g., hypotension, hypoxemia, hypocapnia, hyperglycemia). Management of brain injury in septic patients is first focused to exclude structural intracranial complications (e.g., ischemic/hemorrhagic stroke) and possible confounders (e.g., electrolyte alterations or metabolic disorders, such as dysglycemia). Sepsis-associated brain dysfunction is frequently a heterogeneous syndrome. Despite increasing understanding of main pathophysiologic determinants, therapy is essentially limited to protect the brain against further cerebral damage, by way of "simple" therapeutic manipulations of cerebral perfusion and oxygenation and by avoiding over-sedation. Non-invasive monitoring of cerebral perfusion and oxygenation with transcranial Doppler (TCD) and near-infrared spectroscopy (NIRS) is feasible in septic patients. Electroencephalography (EEG) allows detection of sepsis-related seizures and holds promise also as sedation monitoring. Brain CT-scan detects intra-cerebral structural lesions, while magnetic resonance imaging (MRI) provides important insights into primary mechanisms of sepsis-related direct brain injury, (e.g., cytotoxic vs. vasogenic edema) and the development of posterior reversible encephalopathy. Together with EEG and evoked potentials (EP), MRI is also important for coma prognostication. Emerging clinical evidence suggests monitoring of the brain in septic patients can be implemented in the ICU. The objective of this review was to summarize recent clinical data about the role of brain monitoring - including TCD, NIRS, EEG, EP, CT, and MRI - in patients with sepsis and to illustrate its potential utility for the diagnosis, management and prognostication.
Mots-clé
Ultrasonography, Doppler, transcranial, Spectroscopy, near-infrared, Cerebrovascular circulation, Homeostasis, Brain
Pubmed
Web of science
Création de la notice
03/11/2015 19:47
Dernière modification de la notice
03/03/2018 19:22
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