Carbon Dioxide; Adult; Aged; Blood Flow Velocity/physiology; Blood Gas Analysis/methods; Carbon Dioxide/blood; Cerebrovascular Circulation/physiology; Child, Preschool; Female; Humans; Male; Respiration, Artificial/methods; Systemic Inflammatory Response Syndrome/blood; Systemic Inflammatory Response Syndrome/physiopathology; Critical Care and Intensive Care Medicine
Abstract :
[en] [en] BACKGROUND: Most patients with sepsis develop potentially irreversible cerebral dysfunctions. It is yet not clear whether cerebral haemodynamics are altered in these sepsis patients at all, and to what extent. We hypothesized that cerebral haemodynamics and carbon dioxide reactivity would be impaired in patients with sepsis syndrome and pathological electroencephalogram patterns.
METHODS: After approval of the institutional ethics committee, 10 mechanically ventilated patients with sepsis syndrome and pathological electroencephalogram patterns underwent measurements of cerebral blood flow and jugular venous oxygen saturation before and after reduction of the arterial carbon dioxide partial pressure by 0.93 +/- 0.7 kPa iu by hyperventilation. The cerebral capillary closing pressure was determined from transcranial Doppler measurements of the arterial blood flow of the middle cerebral artery and the arterial pressure curve. A t test for matched pairs was used for statistical analysis (P < 0.05).
RESULTS: During stable mean arterial pressure and cardiac index, reduction of the arterial carbon dioxide partial pressure led to a significant increase of the capillary closing pressure from 25 +/- 11 mmHg to 39 +/- 15 mmHg (P < 0.001), with a consecutive decrease of blood flow velocity in the middle cerebral artery of 21.8 +/- 4.8%/kPa (P < 0.001), of cerebral blood flow from 64 +/- 29 ml/100 g/min to 39 +/- 15 ml/100 g/min (P < 0.001) and of jugular venous oxygen saturation from 75 +/- 8% to 67 +/- 14% (P < 0.01).
CONCLUSION: In contrast to other experimental and clinical data, we observed no pathological findings in the investigated parameters of cerebral perfusion and oxygenation.
Disciplines :
Neurology
Author, co-author :
Thees, Christof; Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, 53105 Bonn, Germany. christof.thees@ukb.uni-bonn.de
Kaiser, Markus; Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany
Scholz, Martin; Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany
Semmler, Alexander; Department of Neurology, University of Bonn, Bonn, Germany
HENEKA, Michael ; Department of Neurology, University of Bonn, Bonn, Germany
Baumgarten, Georg; Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany
Hoeft, Andreas; Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany
Putensen, Christian; Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany
External co-authors :
yes
Language :
English
Title :
Cerebral haemodynamics and carbon dioxide reactivity during sepsis syndrome.
Young GB, Bolton CF, Austin TW, Archibald YM, Gonder J, Wells GA. The encephalopathy associated with septic illness. Clin Invest Med 1990, 13:297-304.
Eggers V, Schilling A, Kox WJ, Spies C. Septic encephalopathy. Diagnosis and therapy. Anaesthesist 2003, 52:294-303. 10.1007/s00101-003-0496-9, 12715131.
Young GB, Bolton CF, Archibald YM, Austin TW, Wells GA. The electroencephalogram in sepsis-associated encephalopathy. J Clin Neurophysiol 1992, 9:145-152.
Eidelman LA, Putterman D, Putterman C, Sprung CL. The spectrum of septic encephalopathy. Definitions, etiologies, and mortalities. JAMA 1996, 275:470-473. 10.1001/jama.275.6.470, 8627969.
Terborg C, Schummer W, Albrecht M, Reinhart K, Weiller C, Röther J. Dysfunction of vasomotor reactivity in severe sepsis and septic shock. Intensive Care Med 2001, 27:1231-1234. 10.1007/s001340101005, 11534574.
Bowie RA, O'Connor PJ, Mahajan RP. Cerebrovascular reactivity to carbon dioxide in sepsis syndrome. Anaesthesia 2003, 58:261-279. 10.1046/j.1365-2044.2003.29671.x, 12638565.
Rudinsky BF, Lozon M, Bell A, Hipps R, Meadow WL. Group B streptococcal sepsis impairs cerebral vascular reactivity to acute hypercarbia in piglets. Pediatr Res 1996, 39:55-63. 10.1203/00006450-199601000-00008, 8825386.
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992, 20:864-874. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference.
Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995, 23:1638-1652. 10.1097/00003246-199510000-00007, 7587228.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985, 13:818-829. 10.1097/00003246-198510000-00009, 3928249.
Thees C, Scholz M, Schaller C, Gass A, Pavlidis C, Weyland A, Hoeft A. Relationship between intracranial pressure and critical closing pressure in patients with neurotrauma. Anesthesiology 2002, 96:595-599. 10.1097/00000542-200203000-00014, 11873033.
Wietasch GJK, Mielck F, Scholz M, von Spiegel T, Stephan H, Hoeft A. Bedside assessment of cerebral blood flow by double-indicator dilution technique. Anesthesiology 2000, 92:367-375. 10.1097/00000542-200002000-00017, 10691222.
Mielck F, Wietasch G, Weyland A, Buhre W, Meier-Theile C, Hoeft A, Sonntag H. Reliability of cerebral blood flow measurements by transcerebral double-indicator dilution technique. Eur J Anaesth 2001, 18:653-661.
Lüders HO, Noachter SS. Atlas and classification of electroencepalography 2000, Philadelphia, A: WB Saunders.
Ramsay MA, Savage TM, Simpson BR, Goodwin R. Controlled sedation with alphaxolone-alphadone. Br Med J 1974, 2:656-659. 1613102, 4835444.
Matta BF, Stow PJ. Sepsis-induced vasoparalysis does not involve the cerebral vasculature: indirect evidence from autoregulation and carbon dioxide reactivity studies. Br J Anaesth 1996, 76:790-794.
Panerai RB. The critical closing pressure of the cerebral circulation. Med Eng Phys 2003, 25:621-632. 10.1016/S1350-4533(03)00027-4, 12900178.
Burton AC. On the physical equilibrium of small blood vessels. Am J Physiol 1951, 164:319-329.
Permutt S, Riley RL. Hemodynamics of collapsible vessels with tone: the vascular waterfall. J Appl Physiol 1963, 18:924-932.
Weyland A, Buhre W, Grund S, Ludwig H, Kazmaier S, Weyland W, Sonntag H. Cerebrovascular tone rather than intracranial pressure determines the effective downstream pressure of the cerebral circulation in the absence of intracranial hypertension. J Neurosurg Anesthesiol 2000, 12:210-216. 10.1097/00008506-200007000-00002, 10905568.
Eng C, Lam AM, Mayberg TS, Lee C, Mathisen T. The influence of propofol with and without nitrous oxide on cerebral blood flow velocity and CO2 reactivity in humans. Anesthesiology 1992, 77:872-879. 10.1097/00000542-199211000-00006, 1443739.
Smith SM, Padayachee S, Moderasi KB, Smithies MN, Bihari DJ. Cerebral blood flow is proportional to cardiac index in patients with septic shock. J Crit Care 1998, 13:104-109. 10.1016/S0883-9441(98)90013-2, 9758024.
Schütt S, Horn P, Roth H, Quintel M, Schilling L, Schmiedek P, Scüre L. Bedside monitoring of cerebral blood flow by transcranial thermo-dye-dilution technique in patients suffering from severe traumatic brain injury or subarachnoid hemorrhage. J Neurotrauma 2001, 18:595-605. 10.1089/089771501750291837, 11437082.
Keller E, Wietasch G, Ringleb P, Scholz M, Schwarz S, Stingele R, Schwab S, Hanley D, Hacke W. Bedside monitoring of cerebral blood flow in patients with acute hemispheric stroke. Crit Care Med 2000, 28:511-516. 10.1097/00003246-200002000-00037, 10708192.
Olesen J, Paulson OB, Lassen NA. Regional cerebral blood flow in man determined by the initial slope of the clearance of intra-arterially injected 133Xe. Stroke 1971, 2:519-540.
Wijdicks EFM, Stevens M. The role of hypotension in septic encephalopathy following surgical procedures. Arch Neurol 1992, 49:653-656.
