Ricerca avanzata

Home > Riviste > Minerva Anestesiologica > Fascicoli precedenti > Minerva Anestesiologica 2015 Luglio;81(7) > Minerva Anestesiologica 2015 Luglio;81(7):776-88

FASCICOLI E ARTICOLI   I PIÙ LETTI   eTOC

ULTIMO FASCICOLOMINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,036

Periodicità: Mensile

ISSN 0375-9393

Online ISSN 1827-1596

 

Minerva Anestesiologica 2015 Luglio;81(7):776-88

 EXPERT OPINION

How to monitor the brain in septic patients?

Oddo M. 1, Taccone F. S. 2

1 Department of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital, Faculty of Biology and Medicine, Lausanne, Switzerland;
2 Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

Brain injury is frequently observed after sepsis and may be primarily related to the direct effects of the septic insult on the brain (e.g., brain edema, ischemia, seizures) or to secondary/indirect injuries (e.g., hypotension, hypoxemia, hypocapnia, hyperglycemia). Management of brain injury in septic patients is first focused to exclude structural intracranial complications (e.g., ischemic/hemorrhagic stroke) and possible confounders (e.g., electrolyte alterations or metabolic disorders, such as dysglycemia). Sepsis-associated brain dysfunction is frequently a heterogeneous syndrome. Despite increasing understanding of main pathophysiologic determinants, therapy is essentially limited to protect the brain against further cerebral damage, by way of “simple” therapeutic manipulations of cerebral perfusion and oxygenation and by avoiding over-sedation. Non-invasive monitoring of cerebral perfusion and oxygenation with transcranial Doppler (TCD) and near-infrared spectroscopy (NIRS) is feasible in septic patients. Electroencephalography (EEG) allows detection of sepsis-related seizures and holds promise also as sedation monitoring. Brain CT-scan detects intra-cerebral structural lesions, while magnetic resonance imaging (MRI) provides important insights into primary mechanisms of sepsis-related direct brain injury, (e.g., cytotoxic vs. vasogenic edema) and the development of posterior reversible encephalopathy. Together with EEG and evoked potentials (EP), MRI is also important for coma prognostication.
Emerging clinical evidence suggests monitoring of the brain in septic patients can be implemented in the ICU. The objective of this review was to summarize recent clinical data about the role of brain monitoring – including TCD, NIRS, EEG, EP, CT, and MRI – in patients with sepsis and to illustrate its potential utility for the diagnosis, management and prognostication.

lingua: Inglese


FULL TEXT  ESTRATTI

inizio pagina