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Estimated Cerebral Perfusion Pressure and Intracranial Pressure in Septic Patients

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Abstract

Background

Sepsis-associated brain dysfunction (SABD) is frequent and is associated with poor outcome. Changes in brain hemodynamics remain poorly described in this setting. The aim of this study was to investigate the alterations of cerebral perfusion pressure and intracranial pressure in a cohort of septic patients.

Methods

We conducted a retrospective analysis of prospectively collected data in septic adults admitted to our intensive care unit (ICU). We included patients in whom transcranial Doppler recording performed within 48 h from diagnosis of sepsis was available. Exclusion criteria were intracranial disease, known vascular stenosis, cardiac arrhythmias, pacemaker, mechanical cardiac support, severe hypotension, and severe hypocapnia or hypercapnia. SABD was clinically diagnosed by the attending physician, anytime during the ICU stay. Estimated cerebral perfusion pressure (eCPP) and estimated intracranial pressure (eICP) were calculated from the blood flow velocity of the middle cerebral artery and invasive arterial pressure using a previously validated formula. Normal eCPP was defined as eCPP ≥ 60 mm Hg, low eCPP was defined as eCPP < 60 mm Hg; normal eICP was defined as eICP ≤ 20 mm Hg, and high eICP was defined as eICP > 20 mm Hg.

Results

A total of 132 patients were included in the final analysis (71% male, median [interquartile range (IQR)] age was 64 [52–71] years, median [IQR] Acute Physiology and Chronic Health Evaluation II score on admission was 21 [15–28]). Sixty-nine (49%) patients developed SABD during the ICU stay, and 38 (29%) were dead at hospital discharge. Transcranial Doppler recording lasted 9 (IQR 7–12) min. Median (IQR) eCPP was 63 (58–71) mm Hg in the cohort; 44 of 132 (33%) patients had low eCPP. Median (IQR) eICP was 8 (4–13) mm Hg; five (4%) patients had high eICP. SABD occurrence and in-hospital mortality did not differ between patients with normal eCPP and patients with low eCPP or between patients with normal eICP and patients with high eICP. Eighty-six (65%) patients had normal eCPP and normal eICP, 41 (31%) patients had low eCPP and normal eICP, three (2%) patients had low eCPP and high eICP, and two (2%) patients had normal eCPP and high eICP; however, SABD occurrence and in-hospital mortality were not significantly different among these subgroups.

Conclusions

Brain hemodynamics, in particular CPP, were altered in one third of critically ill septic patients at a steady state of monitoring performed early during the course of sepsis. However, these alterations were equally common in patients who developed or did not develop SABD during the ICU stay and in patients with favorable or unfavorable outcome.

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Abbreviations

ABG:

Arterial blood gases

AP:

Arterial pressure

APACHE II:

Acute physiology and chronic health evaluation II

CPP:

Cerebral perfusion pressure

eCPP:

Estimated cerebral perfusion pressure

eICP:

Estimated intracranial pressure

FiO2 :

Fraction of inspired oxygen

FV:

Flow velocity

FVd:

Diastolic flow velocity

FVm:

Mean flow velocity

hICP:

High intracranial pressure

ICP:

Intracranial pressure

ICU:

Intensive care unit

lCPP:

Low cerebral perfusion pressure

MAP:

Mean arterial pressure

MCA:

Middle cerebral artery

nCPP:

Normal cerebral perfusion pressure

nICP:

Normal intracranial pressure

PaCO2 :

Partial pressure of carbon dioxide

PaO2 :

Partial pressure of oxygen

PEEP:

Positive end-expiratory pressure

SABD:

Sepsis-associated brain dysfunction

ScvO2 :

Central venous oxygen saturation

STROBE:

Strengthening the reporting of observational studies in epidemiology

TCD:

Transcranial Doppler

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Funding

No funding was received for the present study. IAC, JC, NG, and FST are supported by the Fonds d’Excellence of Fondation Erasme (2015–2021).

Author information

Authors and Affiliations

  1. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium

    Ilaria Alice Crippa, Jean-Louis Vincent, Federica Zama Cavicchi, Selene Pozzebon, Jacques Creteur & Fabio Silvio Taccone

  2. Department of Anesthesiology and Intensive Care, Policlinico San Marco, Gruppo San Donato, Corso Europa 7, 24046, Zingonia, Italy

    Ilaria Alice Crippa

  3. Department of Neurology, Erasme Hospital, Université Libre de Bruxelles (ULB), Route de Lennik 808, 1070, Brussels, Belgium

    Nicolas Gaspard & Christelle Maenhout

Authors
  1. Ilaria Alice Crippa
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  2. Jean-Louis Vincent
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  3. Federica Zama Cavicchi
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  4. Selene Pozzebon
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  5. Nicolas Gaspard
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  6. Christelle Maenhout
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  7. Jacques Creteur
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  8. Fabio Silvio Taccone
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Contributions

Conceptualization: FST, IAC; methodology: IAC, FST; investigation: IAC, FZC, SP, CM; analysis of data: IAC; writing original draft: IAC; review and editing: IAC, JLV, FZC, SP. NG, CM, JC, FST. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ilaria Alice Crippa.

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Conflicts of Interest

The authors declare that they have no competing interests.

Ethical Approval/Informed Consent

The study protocol was approved by the Ethics Committee of the Erasme Hospital (P2021/493), which waived the need for an informed consent because of the retrospective analysis of anonymized data.

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Crippa, I.A., Vincent, JL., Zama Cavicchi, F. et al. Estimated Cerebral Perfusion Pressure and Intracranial Pressure in Septic Patients. Neurocrit Care 40, 577–586 (2024). https://doi.org/10.1007/s12028-023-01783-5

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