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Minerva Anestesiologica 2022 Jul 14

DOI: 10.23736/S0375-9393.22.16689-7

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

What’s new on septic encephalopathy? Ten things you need to know

Lorenzo FERLINI, Nicolas GASPARD

Department of Neurology, Hôpital Universitaire de Bruxelles (Hôpital Erasme), Université Libre de Bruxelles, Bruxelles, Belgium


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Sepsis associated encephalopathy (SAE) is a frequent complication of sepsis and is associated with a higher risk of short-term mortality and long-term cognitive impairment. The EEG is a sensitive complement to the clinical examination that can also detect and quantify encephalopathy and identify features with prognostic value, such has lack of reactivity. Moreover, despite their effect on outcome is still debated, the EEG is the only tool to detect non-convulsive seizures which can occur in a septic setting. Understanding the pathophysiology of SAE is fundamental to define potential therapeutic targets. Neuroinflammation plays a important role in the development of SAE and many blood and imaging biomarkers have recently shown a promising ability to distinguish SAE form non-SAE patient. In recent years, some interesting mediators of inflammation were successfully targeted in animal models, with a significant reduction in the neuroinflammation and in sepsis-induced cognitive decline. However, the complexity of the host response to sepsis currently limits the use of immunomodulation therapies in humans. Alteration in regulatory systems of cerebral blood flow, namely cerebral autoregulation (CA) and neurovascular coupling, contribute to SAE development. Nowadays, clinicians have access to different tools to assess them at the bedside and CA-based blood pressure protocols should be implemented to optimize cerebral prefusion. Its inauspicious consequences, its complex physiopathology and the lack of efficacious treatment makes of SAE a highly active research subject.


KEY WORDS: Continuous EEG; Neuroinflammation; Cerebral autoregulation; Encephalopathy; Sepsis

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