Effects of short-term mechanical hyperventilation on cerebral blood flow and dynamic cerebral autoregulation in critically ill patients with sepsis

Berg, Ronan M. G.; Plovsing, RR

doi:10.3109/00365513.2015.1137350

Cited by 13 publications

(20 citation statements)

References 51 publications

(109 reference statements)

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“…The remaining 74 articles underwent full article review and of these studies, and 24 studies were included in the final analysis—15 pre‐clinical (Table ) 7,8,20‐32 and nine clinical (Table 1). 5,12,33‐39 The pre‐clinical studies included 547 animals and the clinical studies included 5022 subjects. Study quality for each study is described in Tables S2 and S3.…”

Section: Resultsmentioning

confidence: 99%

“…PaCO 2 , partial pressure of carbondioxide nine clinical (Table 1). 5,12,[33][34][35][36][37][38][39] The pre-clinical studies included 547 animals and the clinical studies included 5022 subjects. Study quality for each study is described in Tables S2 and S3.…”

Section: Search and Selectionmentioning

confidence: 99%

“…Two of the studies, which were deemed good quality, examined cerebral autoregulation. One study suggested that cerebral CO 2 reactivity is preserved in sepsis, 33 while the other found cerebral autoregulation was attenuated in the setting of hypercapnia. 36 The remaining two studies examined cerebral perfusion, and both showed higher PaCO 2 levels were associated with increased cerebral perfusion 35,36 ; however, both studies were deemed to have a risk of bias.…”

Section: Hemodynamics Of Hypocapniamentioning

confidence: 99%

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Effects of hypercapnia in sepsis: A scoping review of clinical and pre‐clinical data

Clyde

Coletta

Jones

et al. 2020

Acta Anaesthesiol Scand

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Background Perform a scoping review of (1) pre‐clinical studies testing the physiological effects of higher PaCO2 levels in the setting of sepsis models and (2) clinical investigations testing the effects of hypercapnia on clinical outcomes in mechanically ventilated patients with sepsis. Methods We performed a search of CENTRAL, PUBMED, CINAHL, and EMBASE. Study inclusion criteria for pre‐clinical studies were: (1) bacterial sepsis model (2) measurement of PaCO2, and (3) comparison of outcome measure between different PaCO2 levels. Inclusion criteria for clinical studies were: (1) diagnosis of sepsis, (2) receiving invasive mechanical ventilation, (3) measurement of PaCO2, and (4) comparison of outcomes between different PaCO2 levels. We performed a qualitative analysis to collate and summarize the physiological and clinical effects of hypercapnia according to the recommended methodology from the Cochrane Handbook. Results Fifteen pre‐clinical and nine clinical studies were included. Among pre‐clinical studies, the individual studies found higher PaCO2 augments tissue blood flow and oxygenation, and attenuates inflammation and lung injury; however, all pre‐clinical studies were found to have some degree of risk of bias. Six of the nine clinical studies were deemed to be good quality. Among clinical studies hypercapnia was associated with increased cerebral perfusion and oxygenation; however, there were conflicting results testing the association between hypercapnia and mortality. Conclusion While individual pre‐clinical studies identified potential mechanisms by which changes in PaCO2 levels could affect pathophysiology in sepsis, there is a paucity of clinical data as to the optimal PaCO2 range, demonstrating a need for future research. Registration PROSPERO number CRD42018086703.

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Section: Resultsmentioning

confidence: 99%

Section: Search and Selectionmentioning

confidence: 99%

Section: Hemodynamics Of Hypocapniamentioning

confidence: 99%

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Effects of hypercapnia in sepsis: A scoping review of clinical and pre‐clinical data

Clyde

Coletta

Jones

et al. 2020

Acta Anaesthesiol Scand

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“…109,110,113,114 Several studies have evaluated cerebrovascular reactivity in sepsis, generally finding it to be normal or increased. 40,106,111,[115][116][117] Vaskó et al 115 reported increased rScO 2 after the administration of acetazolamide suggesting preserved cerebrovascular reactivity in patients with severe sepsis but point out that this could be artefactual. The increased rScO 2 was likely due to selective arteriolar vasodilation from acetazolamide which NIRS algorithms misinterpret as increased CBF given their assumption of a fixed arterial:venous ratio.…”

Section: Cbf Autoregulation In Sepsismentioning

confidence: 99%

Cerebral Blood Flow Autoregulation in Sepsis for the Intensivist: Why Its Monitoring May Be the Future of Individualized Care

Goodson

Rosenblatt

Rivera‐Lara

et al. 2016

J Intensive Care Med

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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. 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. 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.

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“…Indeed, monitoring CA has shown to be particularly useful in the context of acute subarachnoid hemorrhage, traumatic brain injury (TBI), and acute stroke (2)(3)(4)(5). Although no randomized controlled trials (RCTs) assessing the effect of autoregulation on outcome are available at present, it is accepted among experts that impairment of CA can lead to secondary cerebral insult and poor outcomes also in patients without primary brain injury (6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Cerebral Autoregulation in Non-Brain Injured Patients: A Systematic Review

et al. 2021

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Introduction: Cerebral autoregulation (CA) plays a fundamental role in the maintenance of adequate cerebral blood flow (CBF). CA monitoring, through direct and indirect techniques, may guide an appropriate therapeutic approach aimed at improving CBF and reducing neurological complications; so far, the role of CA has been investigated mainly in brain-injured patients. The aim of this study is to investigate the role of CA in non-brain injured patients.Methods: A systematic consultation of literature was carried out. Search terms included: “CA and sepsis,” “CA and surgery,” and “CA and non-brain injury.”Results: Our research individualized 294 studies and after screening, 22 studies were analyzed in this study. Studies were divided in three groups: CA in sepsis and septic shock, CA during surgery, and CA in the pediatric population. Studies in sepsis and intraoperative setting highlighted a relationship between the incidence of sepsis-associated delirium and impaired CA. The most investigated setting in the pediatric population is cardiac surgery, but the role and measurement of CA need to be further elucidated.Conclusion: In non-brain injured patients, impaired CA may result in cognitive dysfunction, neurological damage, worst outcome, and increased mortality. Monitoring CA might be a useful tool for the bedside optimization and individualization of the clinical management in this group of patients.

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Effects of short-term mechanical hyperventilation on cerebral blood flow and dynamic cerebral autoregulation in critically ill patients with sepsis

Cited by 13 publications

References 51 publications

Effects of hypercapnia in sepsis: A scoping review of clinical and pre‐clinical data

Effects of hypercapnia in sepsis: A scoping review of clinical and pre‐clinical data

Cerebral Blood Flow Autoregulation in Sepsis for the Intensivist: Why Its Monitoring May Be the Future of Individualized Care

Cerebral Autoregulation in Non-Brain Injured Patients: A Systematic Review

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