Cerebral blood flow autoregulation in sepsis for the intensivist why its monitoring may be the future of individualized care. hypoxia anoxia

Summary of cerebral blood flow autoregulation in sepsis for the intensivist: why its monitoring may be the future of individualized care.

Cerebral blood flow (CBF) autoregulation maintains consistent blood flow across a range of blood pressures (bps). Sepsis is a common cause of systemic hypotension and cerebral dysfunction. Guidelines for BP management in sepsis are based on historical concepts of CBF autoregulation that have now evolved with the availability of more precise technology for its measurement. In this article, we provide a narrative review of methods of monitoring CBF autoregulation, the cerebral effects of sepsis, and the current knowledge of CBF autoregulation in sepsis.


Current guidelines for BP management in sepsis are based on a goal of maintaining mean arterial pressure (MAP) above the lower limit of CBF autoregulation.Hypoxia anoxia bedside tools are now available to monitor CBF autoregulation continuously. These data reveal that individual BP goals determined from CBF autoregulation monitoring are more variable than previously expected. In patients undergoing cardiac surgery with cardiopulmonary bypass, for example, the lower limit of autoregulation varied between a MAP of 40 to 90 mm hg. Studies of CBF autoregulation in sepsis suggest patients frequently manifest impaired CBF autoregulation, possibly a result of BP below the lower limit of autoregulation, particularly in early sepsis or with sepsis-associated encephalopathy. This suggests that the present consensus guidelines for BP management in sepsis may expose some patients to both cerebral hypoperfusion and cerebral hyperperfusion, potentially resulting in damage to brain parenchyma.Hypoxia anoxia the future use of novel techniques to study and clinically monitor CBF autoregulation could provide insight into the cerebral pathophysiology of sepsis and offer more precise treatments that may improve functional and cognitive outcomes for survivors of sepsis. Affiliation

Journal details

This article was published in the following journal.

Name: journal of intensive care medicine ISSN: 1525-1489 pages: links

• pubmed source: http://www.Ncbi.Nlm.Nih.Gov/pubmed/27798314

• DOI: http://dx.Doi.Org/10.1177/0885066616673973

PubMed articles

[ 18954 associated pubmed articles listed on bioportfolio]

Dynamic autoregulation of cerebral blood flow measured non-invasively with fast diffuse correlation spectroscopy.Hypoxia anoxia

Cerebral autoregulation (CA) maintains cerebral blood flow (CBF) in the presence of systemic blood pressure changes. Brain injury can cause loss of CA and resulting dysregulation of CBF, and the degre…

Applying time-frequency analysis to assess cerebral autoregulation during hypercapnia.

Classic methods for assessing cerebral autoregulation involve a transfer function analysis performed using the fourier transform to quantify relationship between fluctuations in arterial blood pressur…

Novel method for intraoperative assessment of cerebral autoregulation by paced breathing.

Cerebral autoregulation (CA) is the mechanism that maintains constancy of cerebral blood flow (CBF) despite variations in blood pressure (BP).Hypoxia anoxia patients with attenuated CA have been shown to have an in…

Non-linear models for the detection of impaired cerebral blood flow autoregulation.

The ability to discriminate between normal and impaired dynamic cerebral autoregulation (CA), based on measurements of spontaneous fluctuations in arterial blood pressure (BP) and cerebral blood flow …

Blood flow and continuous EEG changes during symptomatic plateau waves.

Benign meningiomas uncommonly lead to significant cerebral edema, with only a few cases previously reported in the medical literature. The present study describes the case of a 49-year-old female who …

Clinical trials

[ 10086 associated clinical trials listed on bioportfolio]

Continous assessment of cerebral autoregulation with near-infrared spectroscopy

hypoxia anoxia

Cerebral autoregulation can be explained by a tight coupling between oxygen supply and

Demand of the brain, and is essential to maintain a constant cerebral blood flow (CBF) in

The context…

Feasibility of improving cerebral autoregulation in acute intracerebral haemorrhage

In the UK, 23,000 (15%) of the 150,000 people who suffer a stroke each year have bleeding in

The brain, also referred to as acute intracerebral haemorrhage (ICH). An autoregulation index

(…

Neuroimaging and neuromonitoring in critically ill children with sepsis

In critically ill children with severe sepsis, neurophysiologic derangements often proceed

Undetected and can lead to irreversible brain injury causing neurocognitive and behavioral

hypoxia anoxia

Defici…

The effect of an α2-adrenoceptor antagonist (yohimbine) on dynamic autoregulation in the human middle cerebral artery and ophthalmic artery

Blood flow autoregulation is defined as the ability of a tissue to maintain a relatively

Constant flow, despite moderate alterations in perfusion pressure. Similar to the cerebral,

Renal, …

Carotid VTI as a measure of intravascular volume status during lower body negative pressure simulation

Ultrasound represents an attractive non-invasive method to assess hemodynamic status.

Understanding dynamic changes in hemodynamics in situations such as hypovolemia, sepsis, and

Cardiogen…

Hypertensive encephalopathy

Brain dysfunction or damage resulting from sustained MALIGNANT HYPERTENSION.Hypoxia anoxia when BLOOD PRESSURE exceeds the limits of cerebral autoregulation, cerebral blood flow is impaired (BRAIN ISCHEMIA). Clinical manifestations include HEADACHE; NAUSEA; VOMITING; SEIZURES; altered mental status (in some cases progressing to COMA); PAPILLEDEMA; and RETINAL HEMORRHAGE.

Ultrasonography, doppler, transcranial

A non-invasive technique using ultrasound for the measurement of cerebrovascular hemodynamics, particularly cerebral blood flow velocity and cerebral collateral flow. With a high-intensity, low-frequency pulse probe, the intracranial arteries may be studied transtemporally, transorbitally, or from below the foramen magnum.

Sepsis

Systemic inflammatory response syndrome with a proven or suspected infectious etiology.Hypoxia anoxia when sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by HYPOTENSION despite adequate fluid infusion, it is called SEPTIC SHOCK.

Sepsis-associated encephalopathy

Acute neurological dysfunction during severe SEPSIS in the absence of direct brain infection characterized by systemic inflammation and BLOOD BRAIN BARRIER perturbation.

Renal plasma flow

The amount of PLASMA that perfuses the KIDNEYS per unit time, approximately 10% greater than effective renal plasma flow (RENAL PLASMA FLOW, EFFECTIVE). It should be differentiated from the RENAL BLOOD FLOW; (RBF), which refers to the total volume of BLOOD flowing through the renal vasculature, while the renal plasma flow refers to the rate of plasma flow (RPF).Hypoxia anoxia