Abstract
Objective
Sepsis or systemic inflammatory response syndrome (SIRS) is often associated with encephalopathy (70%), which has been described as an early symptom resulting in several diseases. The present study investigated somatosensory evoked potentials (SEP) as an indicator or even a predictor of cerebral dysfunction evaluated in an experimental model of SIRS in pigs.
Methods
Eight Göttinger minipigs were included in the study. SIRS was mediated by induction of pancreatitis due to injection (ductus pancreaticus) of 500 mg/kg sodium taurocholate and 2.5 IU/kg enterokinase. Monitored parameters were: arterial blood—central venous—pulmonary arterial pressure, and cardiac output, systemic vascular resistance, and body temperature. SEP were recorded from centroparietal vs. frontal areas after electrical stimulation of the right forepaw.
Results
At least 33% loss of vascular resistance from baseline (SIRS criteria) occurred in all animals within 4–18 h. Baseline recordings in all anesthetized animals indicated primary cortical responses to electrical stimuli identified by peak latencies between 15–20 ms (SEPP15–20). Attenuations in the amplitudes with significant median decreases of 46% were observed at least 4 h before the defined hemodynamic SIRS criteria.
Conclusions
The present data show a trend for the attenuation in SEP amplitudes as an indicator of systemic inflammatory response. SEP monitoring may be a sensitive marker of developing early changes in cerebral function due to SIRS-related encephalopathy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Schwarz S, Schwab S, Fabian CW, Schellinger P, Orberk E, Hund E (1997) Infection impaired consciousness as the initial symptom. Clinical and pathophysiologic aspects of septic encephalopathy sepsis: unklare Bewusstseinstrübung als Initialsymptom. Klinik und Pathophysiologie der septischen Enzephalopathie. Nervenarzt 68:292–297
Young GB, Bolton CF, Austin TW (1993) Definitions for sepsis and organ failure. Crit Care Med 21:808
Bolton CF, Young GB, Zochodne DW (1993) The neurological complications of sepsis. Ann Neurol 33:94–100
Eidelman LA, Putterman D, Putterman C, Sprung CL (1996) The spectrum of septic encephalopathy. Definitions, etiologies, and mortalities. JAMA 275:470–473
Sprung CL, Peduzzi PN, Shatney CH, Schein RMH, Wilson MF, Sheagren JN, Hinshaw LB (1990) Impact of encephalopathy on mortality in the sepsis syndrome. Crit Care Med 18:801–806
Young GB, Bolton CF, Austin TW, Archibald YM, Gonder J, Wells GA (1990) The encephalopathy associated with septic illness. Clin Invest Med 13:297–304
Young GB, Bolton CF, Archibald YM, Austin TW, Wells GA (1992) The electroencephalogram in sepsis-associated encephalopathy. J Clin Neurophysiol 9:145–152
Yekebas EF, Treede H, Knoefel WT, Bloechle C, Fink E, Izbicki JR (1999) Influence of zero-balanced hemofiltration on the course of severe experimental pancreatitis in pigs. Ann Surg 229:514–522
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874
Hannon JP, Bossone CA, Wade CE (1990) Normal physiological values for conscious pigs used in biomedical research. Lab Anim Sci 40:293–298
Jordan C, Weller C, Thornton C, Newton DE (1995) Monitoring evoked potentials during surgery to assess the level of anaesthesia. J Med Eng Technol 19:77–79
Andrews RJ, Knight RT, Kirby RP (1990) Evoked potential mapping of auditory and somatosensory cortices in the miniature swine. Neurosci Lett 114:27–31
Thornton C (1991) Evoked potentials in anaesthesia. Eur J Anaesthesiol 8:89–107
Bogdanski R, Blobner M, Hanel F, Kochs E (1999) Septic encephalopathy Anasthesiol Intensivmed Notfallmed Schmerzther 34:123–130
Freund HR, Muggia-Sullam M, Peiser J, Melamed E (1985) Brain neurotransmitter profile is deranged during sepsis and septic encephalopathy in the rat. J Surg Res 38:267–271
Freund HR, Muggia-Sullam M, LaFrance R, Holroyde J, Fischer JE (1986) Regional brain amino acid and neurotransmitter derangements during abdominal sepsis and septic encephalopathy in the rat. The effect of amino acid infusions. Arch Surg 121:209–216
Palmer RM (1993) The discovery of nitric oxide in vessel wall. A unifying concept in the pathogenesis of sepsis. Arch Surg 128:396–401
Zauner C, Gendo A, Kramer L, Kranz A, Grimm G, Madl C (2000) Metabolic encephalopathy in critically ill patients suffering from septic or nonseptic organ failure. Crit Care Med 28:1310–1315
Deutschman CS, Kirsch JR, Breslow MJ, Miller CF, Traystman RJ (1990) Failure of endotoxic shock to elicit superoxide anion production in pig brain. Circ Shock 31:149–158
Hund E (1996) Neuromuscular complications in the ICU: the spectrum of critical illness related conditions causing muscular weakness and weaning failure. J Neurol Sci 136:10–16
Zauner C, Gendo A, Kramer L, Funk GC, Bauer E, Schenk P, Ratheiser K, Madl C (2002) Impaired subcortical and cortical sensory evoked potential pathways in septic patients. Crit Care Med 30:1136–1139
Kadoi Y, Saito S, Kunimoto F, Imai T, Fujita T (1996) Impairment of the brain beta-adrenergic system during experimental endotoxemia. J Surg Res 61:496–502
Miller CF, Breslow MJ, Sharpiro RM, Traystman RJ (1988) Role of hypotension in decreasing cerebral blood flow in procine endotoxemia. Am J Physiol 253:956–964
McPherson RW, Eimeri D, Traystman RJ (1987) Interaction of hypoxia and hypercapnia on cerebral hemodynamics and brain electrical activity in dogs. Am J Physiol 253:890–897
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ohnesorge, H., Bischoff, P., Scholz, J. et al. Somatosensory evoked potentials as predictor of systemic inflammatory response syndrome in pigs?. Intensive Care Med 29, 801–807 (2003). https://doi.org/10.1007/s00134-003-1657-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-003-1657-7