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Intensive Care Medicine

, Volume 27, Issue 7, pp 1231–1234 | Cite as

Dysfunction of vasomotor reactivity in severe sepsis and septic shock

  • Christoph Terborg
  • Wolfram Schummer
  • Melanie Albrecht
  • Konrad Reinhart
  • Cornelius Weiller
  • Joachim Röther
Brief Report

Abstract.

Objective: Perfusion abnormalities are an overall phenomenon in severe sepsis and septic shock, leading to organ dysfunction. We investigated whether carbon dioxide (CO2)-induced vasomotor reactivity (VMR) is impaired in septic patients, compared with values obtained outside sepsis. Design: Prospective, clinical study. Setting: Six-bed neurologic critical care unit of a university hospital. Patients and participants: Eight consecutive patients with severe sepsis and septic shock. Measurements and results: CO2-reactivity was measured during and outside a period of severe sepsis or septic shock according to ACCP/SCCM criteria by means of transcranial Doppler sonography and near-infrared spectroscopy (NIRS). VMR was calculated as the percentage change of cerebral blood flow velocity (normalized CO2-reactivity, NCR) and absolute changes in concentration of oxygenated hemoglobin, deoxygenated hemoglobin, total hemoglobin (HbO2, Hb, HbT) and Hbdiff (difference between HbO2 and Hb) in µmol/l per 1% increase in end-tidal CO2 (CR-HbO2, CR-Hb, CR-HbT, CR-Hbdiff). NCR and NIRS-reactivities were significantly reduced during severe sepsis and septic shock compared with values outside sepsis (mean, SD, Wilcoxon): NCR 11.0 (7.1) versus 30.7 (13.0), p<0.02; CR-HbO2 0.70 (0.61) versus 2.33 (1.11), p<0.02; CR-Hb –0.17 (0.74) versus –1.42 (1.28), p<0.04; CR-HbT 0.53 (0.48) versus 1.05 (0.40), p<0.03; CR-Hbdiff 0.91 (1.33) versus 3.75 (2.33), p<0.02. This indicates a severely disturbed VMR. Conclusions: In the advent of a disturbed cerebral autoregulation, critical drops in blood pressure during sepsis are transferred directly into the vascular bed, leading to cerebral hypoperfusion. This mechanism might contribute to the pathogenesis of septic encephalopathy.

Sepsis Spectroscopy, near-infrared Ultrasonography, Doppler, transcranial Vasomotor reactivity 

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Copyright information

© Springer-Verlag 2001

Authors and Affiliations

  • Christoph Terborg
    • 1
  • Wolfram Schummer
    • 2
  • Melanie Albrecht
    • 1
  • Konrad Reinhart
    • 2
  • Cornelius Weiller
    • 3
  • Joachim Röther
    • 3
  1. 1.Department of Neurology, Friedrich-Schiller University of Jena, Philosophenweg 3, 07740 Jena, GermanyGermany
  2. 2.Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller University of Jena, Bachstrasse 18, 07740 Jena, GermanyGermany
  3. 3.Department of Neurology, Universitätskrankenhaus Eppendorf, Martinistrasse 52, 20246 Hamburg, GermanyGermany

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