Incidence and pattern of brain lesions in paediatric septic shock patients

Sanz, D.; D’Arco, Felice; Robles, Carlos; Brierley, Joe

doi:10.1259/bjr.20170861

Cited by 18 publications

(15 citation statements)

References 11 publications

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“…Dysfunction of the autonomic nervous system in the brain during sepsis largely determines lethality and severity of systemic inflammation [99][100][101][102][103][104]. However, there are still no specific approaches to assessing the reviews ANS dysfunction and developing specific therapies for its correction.…”

Section: Resultsmentioning

confidence: 99%

Dysfunction of the Autonomic Nervous System and Its Role in the Pathogenesis of Septic Critical Illness (Review)

Kiryachkov

Bosenko

Muslimov³

et al. 2020

Sovrem Tehnol Med

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Dysfunction of the autonomic nervous system (ANS) of the brain in sepsis can cause severe systemic inflammation and even death. Numerous data confirmed the role of ANS dysfunction in the occurrence, course, and outcome of systemic sepsis. The parasympathetic part of the ANS modifies the inflammation through cholinergic receptors of internal organs, macrophages, and lymphocytes (the cholinergic antiinflammatory pathway). The sympathetic part of ANS controls the activity of macrophages and lymphocytes by influencing β2-adrenergic receptors, causing the activation of intracellular genes encoding the synthesis of cytokines (anti-inflammatory beta2-adrenergic receptor interleukin-10 pathway, β2AR-IL-10). The interaction of ANS with infectious agents and the immune system ensures the maintenance of homeostasis or the appearance of a critical generalized infection. During inflammation, the ANS participates in the inflammatory response by releasing sympathetic or parasympathetic neurotransmitters and neuropeptides. It is extremely important to determine the functional state of the ANS in critical conditions, since both cholinergic and sympathomimetic agents can act as either anti-or pro-inflammatory stimuli.

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Section: Resultsmentioning

confidence: 99%

Dysfunction of the Autonomic Nervous System and Its Role in the Pathogenesis of Septic Critical Illness (Review)

Kiryachkov

Bosenko

Muslimov³

et al. 2020

Sovrem Tehnol Med

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“…Sanz et al performed brain imaging of 49 pediatric septic shock patients, and the most frequent acute brain lesion patterns, found on neuroimaging, were ischemia and cerebritis (i.e., cerebral edema/damage in the clinical context of infection) ( 32 ). Sandquist et al studied neuroimaging from septic pediatric patients focusing on long-term abnormalities rather than acute changes.…”

Section: Discussionmentioning

confidence: 99%

Transcranial Doppler Can Predict Development and Outcome of Sepsis-Associated Encephalopathy in Pediatrics With Severe Sepsis or Septic Shock

et al. 2020

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Background and Aim: Sepsis is a common cause of pediatric intensive care unit (ICU) admission. Sepsis-associated encephalopathy (SAE) may occur owing to brain dysfunction in those patients and may be related to impaired cerebral microcirculation. Transcranial Doppler (TCD) can be used to detect this impairment. In this study, we aimed to assess the role of TCD in prediction of SAE and mortality in patients with severe sepsis or septic shock admitted to PICU. Patients and Methods: This prospective study included 75 children admitted to PICU owing to severe sepsis or septic shock. Upon admission, all patients were subjected to careful history taking, thorough clinical examination, and standard laboratory workup. Severity of clinical illness was assessed using the Pediatric Risk of Mortality (PRISM) III score. TCD was performed on the first day of admission after the normalization of systolic blood pressure with or without vasopressors. The primary study outcome was differences in the measurement of TCD in SAE, and the secondary outcome was discharge from ICU or mortality. Results: The study comprised 45 children with SAE and 30 age- and sex-matched children without SAE. In this study, SAE patients had significantly higher pulsatility index [PI; median interquartile range (IQR): 1.15 (0.98–1.48) vs. 1.0 (0.95–1.06), p = 0.002] and resistive index [RI; median (IQR): 0.68 (0.61–0.77) vs. 0.62 (0.59–0.64), p = 0.001] than had non-SAE patients. PI and RI showed good performance as predictors of subsequent SAE development [area under the curve (AUC): 0.72 and 0.73, respectively]. Non-survivors in SAE patients had significantly higher PRISM III. Receiver operating characteristic (ROC) curve analysis showed good performance of PI and RI as predictors of mortality at the end of follow-up. Conclusions: In children with SAE, cerebrovascular resistance is high and is associated with increased mortality.

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“…Sanz et al, performed brain imaging of 49 pediatric septic shock patients, and the most frequent acute brain lesion patterns, found on neuroimaging, were ischemia and cerebritis (i.e., cerebral edema/damage in the clinical context of infection) [30].…”

Section: F-fdg Pet Of the Brain On The 28th Day Of Sepsis And Sae In ...mentioning

confidence: 99%

Diagnostics of Central and Autonomic Nervous System Dysfunction in Patients with Sepsis-Associated Encephalopathy

Savvina¹,

Ryzhkova²,

Bykova³

et al. 2024

Heat Illness and Critical Care

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This chapter is devoted to monitoring of central and autonomic nervous system (ANS) in patients with verified sepsis to recognize the specific functional and anatomic changes in the brain and its important autonomic centers which is named sepsis-associated encephalopathy (SAE). Fluctuation of conscience level from agitation to delirium and coma, muscle tone, and severity of pain syndrome is evaluated with different scales (SOFA, SAPS II, RASS, CAM-ICU, FOUR, PBSS, BPS, MRC, MAS, CNS). Multimodal neuromonitoring includes EEG, EPs, ENMG, cerebral oxymetry, saturation in the bulb of the jugular vein, TCD, and neuroimaging (MRI, PET). Dysfunction of autonomic brainstem structures is detected with variational cardiointervalometry, pupillometry, thermometry (peripheral and central), photoplethysmography assessment of perfusion index, quantitative assessment of muscle strength on the MRC scale and MAS, and diagnostics of the severity of the PSH syndrome. Monitoring data help clinicians to make decisions on SAE patient management tactics.

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Incidence and pattern of brain lesions in paediatric septic shock patients

Cited by 18 publications

References 11 publications

Dysfunction of the Autonomic Nervous System and Its Role in the Pathogenesis of Septic Critical Illness (Review)

Dysfunction of the Autonomic Nervous System and Its Role in the Pathogenesis of Septic Critical Illness (Review)

Transcranial Doppler Can Predict Development and Outcome of Sepsis-Associated Encephalopathy in Pediatrics With Severe Sepsis or Septic Shock

Diagnostics of Central and Autonomic Nervous System Dysfunction in Patients with Sepsis-Associated Encephalopathy

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