Association Between Endothelial Dysfunction and Acute Brain Dysfunction During Critical Illness

Hughes, Christopher; Morandi, Alessandro; Girard, Timothy D.; Riedel, Bernhard; Thompson, Jennifer L.; Shintani, Ayumi; Ely, E. Wesley; Pandharipande, Pratik

doi:10.1097/01.sa.0000443871.68248.a3

Cited by 19 publications

(27 citation statements)

References 36 publications

(36 reference statements)

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“…These data suggest that the inhibition of iNOS-related nitrative stress may attribute to the protective effects of resveratrol against endotoxemia-associated adrenal insufficiency. Endothelial dysfunction, edema, hyperemia and hemorrhage are key characteristics associated with severe inflammation-associated injuries in a variety of organs including lung [38], liver [39], kidney [39] and brain [40]. The adrenal gland is a highly vascularized organ.…”

Section: Discussionmentioning

confidence: 99%

Resveratrol alleviates endotoxemia-associated adrenal insufficiency by suppressing oxidative/nitrative stress

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Resveratrol alleviates endotoxemia-associated adrenal insufficiency by suppressing oxidative/nitrative stress

et al. 2016

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“…Second, it is possible that reductions in perfusion also are associated with underlying cardiovascular disease and/or endothelial dysfunction, which have been associated with both a prolonged neuroinflammatory response and increased blood-brain barrier permeability (36)(37)(38)(39). Reduced cerebral perfusion may also increase the risk of cerebral metabolic dysfunction, which has been shown to worsen following coronary artery bypass graft and correspond to changes in postoperative cognitive performance (35) or increase postoperative neuroinflammation (40)(41)(42).…”

Section: Original Researchmentioning

confidence: 99%

Reduced Cerebral Perfusion Pressure during Lung Transplant Surgery Is Associated with Risk, Duration, and Severity of Postoperative Delirium

et al. 2016

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Rationale: Delirium is common following lung transplant and is associated with poorer clinical outcomes. The extent to which intraoperative hemodynamic alterations may contribute to postoperative delirium among lung transplant recipients has not been examined. Objectives:To examine the impact of intraoperative hemodynamic changes on neurobehavioral outcomes among lung transplant recipients.Methods: Intraoperative hemodynamic function during lung transplant was assessed in a consecutive series of patients between March and November 2013. Intraoperative cerebral perfusion pressure was assessed every minute in all patients. Following lung transplant, patients were monitored for the presence and severity of delirium using the Confusion Assessment Method and the Delirium Rating Scale until hospital discharge.Measurements and Main Results: Sixty-three patients received lung transplants, of whom 23 (37%) subsequently developed delirium. Lower cerebral perfusion pressure was associated with increased risk of delirium (odds ratio [OR], 2.08 per 10-mm Hg decrease; 95% confidence interval [CI], 1.02-4.24; P = 0.043), longer duration of delirium (OR, 1.7 d longer per 10-mm Hg decrease; 95% CI, 1.1-2.7; P = 0.022), and greater delirium severity (b = 20.81; 95% CI, 21.47 to 20.15; P = 0.017).Conclusions: Poorer cerebral perfusion pressure during lung transplant is associated with greater risk for delirium following transplant, as well as greater duration and severity of delirium, independent of demographic and medical predictors. Author Contributions: Concept and design, J.A.B., S.K.R., R.D.D., S.M.P., J.P.M., and P.J.S. Data collection, P.J.S., J.P.M., B.M.H., and S.K.R. Analysis and interpretation of the data, P.J.S., J.P.M., and J.A.B. Drafting of the manuscript, P.J.S., J.P.M., S.M.P., and J.A.B. Critical revision of the article for important intellectual content, P

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“…47 Healthy volunteers injected with endotoxin had decreased cerebral blood flow, and this was associated with peak serum concentrations of TNF-a. 48 Recently, it was demonstrated that patients with lower vascular reactivity had increased duration of brain dysfunction.…”

Section: Introductionmentioning

confidence: 99%

“…48 Recently, it was demonstrated that patients with lower vascular reactivity had increased duration of brain dysfunction. 47 The mechanisms behind endothelial dysfunction and acute brain dysfunction remain unclear, but inflammation could drive structural and functional alterations in the BBB, increasing microvascular permeability and impairing microcirculatory blood flow. [49][50][51][52] These alterations could be secondary to a decrease in the activity of endothelial nitric oxide synthase induced by inflammation 53 or to alterations in the coagulation system, resulting in microthromboses and microinfarcts.…”

Section: Introductionmentioning

confidence: 99%

Septic encephalopathy: does inflammation drive the brain crazy?

Dal‐Pizzol

Tomasi

Ritter

2014

Rev. Bras. Psiquiatr.

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Sepsis and the multiorgan dysfunction syndrome are among the most common reasons for admission to an intensive care unit, and are a leading cause of death. During sepsis, the central nervous system (CNS) is one of the first organs affected, and this is clinically manifested as sepsis-associated encephalopathy (SAE). It is postulated that the common final pathway that leads to SAE symptoms is the deregulation of neurotransmitters, mainly acetylcholine. Thus, it is supposed that inflammation can affect neurotransmitters, which is associated with SAE development. In this review, we will cover the current evidence (or lack thereof) for the mechanisms by which systemic inflammation interferes with the metabolism of major CNS neurotransmitters, trying to explain how systemic inflammation drives the brain crazy.

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Association Between Endothelial Dysfunction and Acute Brain Dysfunction During Critical Illness

Cited by 19 publications

References 36 publications

Resveratrol alleviates endotoxemia-associated adrenal insufficiency by suppressing oxidative/nitrative stress

Resveratrol alleviates endotoxemia-associated adrenal insufficiency by suppressing oxidative/nitrative stress

Reduced Cerebral Perfusion Pressure during Lung Transplant Surgery Is Associated with Risk, Duration, and Severity of Postoperative Delirium

Septic encephalopathy: does inflammation drive the brain crazy?

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