Introduction In sepsis the brain is frequently affected although there is no infection of the CNS (septic encephalop-athy). One possible cause of septic encephalopathy is failure of the blood-brain barrier. Brain edema has been documented in animal models of sepsis. Aggressive fluid resuscitation in the early course of sepsis improves survival and is standard practice. We hypothesized that aggressive fluid administration will increase intracranial pressure (ICP) and may cause critical reductions in cerebral perfusion pressure (CPP).
Materials and methods Patients with sepsis were investigated daily on up to four consecutive days in the intensive care unit. Mean arterial blood pressure (MAP) and blood flow velocity in the middle cerebral artery were monitored for one hour each day. ICP was calculated non-invasively from MAP and flow velocity data. S-100β was determined daily.
Findings Fifty-two measurements were performed in 16 patients. ICP could be determined in 45 measurements in 15 patients. Seven patients had an ICP>15 mmHg and 11 patients had a CPP<60 mmHg on at least 1 day. We found no significant correlation between ICP and fluid administration, but low CPP was significantly correlated with elevated S-100β (r=−0.47, p=0.001).
Conclusions Further research is needed to determine the role of ICP/CPP monitoring in patients with sepsis.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
American College of Chest Physicians/Society of Critical Care Medicine (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874
Anderson RE, Hansson LO, Nilsson O, Dijlai-Merzoug R, Settergren G (2001) High serum S100B levels for trauma patients without head injuries. Neurosurgery 48:1255–1258, discussion 1258–1260
Ari I, Kafa IM, Kurt MA (2006) Perimicrovascular edema in the frontal cortex in a rat model of intraperitoneal sepsis. Exp Neurol 198:242–249
Bowton DL, Bertels NH, Prough DS, Stump DA (1989) Cerebral blood flow is reduced in patients with sepsis syndrome. Crit Care Med 17:399–403
Finelli PF, Uphoff DF (2004) Magnetic resonance imaging abnormalities with septic encephalopathy. J Neurol Neurosurg Psychiatry 75:1189–1191
Hollenberg SM, Ahrens TS, Annane D, Astiz ME, Chalfin DB, Dasta JF, Heard SO, Martin C, Napolitano LM, Susla GM, Totaro R, Vincent JL, Zanotti-Cavazzoni S (2004) Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 32:1928–1948
Kapural M, Krizanac-Bengez L, Barnett G, Perl J, Masaryk T, Apollo D, Rasmussen P, Mayberg MR, Janigro D (2002) Serum S-100beta as a possible marker of blood—brain barrier disruption. Brain Res 940:102–104
Marchi N, Rasmussen P, Kapural M, Fazio V, Kight K, Mayberg MR, Kanner A, Ayumar B, Albensi B, Cavaglia M, Janigro D (2003) Peripheral markers of brain damage and blood—brain barrier dysfunction. Restor Neurol Neurosci 21:109–121
Nguyen DN, Spapen H, Su F, Schiettecatte J, Shi L, Hachimi-Idrissi S, Huyghens L (2006) Elevated serum levels of S-100beta protein and neuron-specific enolase are associated with brain injury in patients with severe sepsis and septic shock. Crit Care Med 34:1967–1974
Papadopoulos MC, Lamb FJ, Moss RF, Davies DC, Tighe D, Bennett ED (1999) Faecal peritonitis causes oedema and neuronal injury in pig cerebral cortex. Clin Sci (Lond) 96:461–466
Papadopoulos MC, Davies DC, Moss RF, Tighe D, Bennett ED (2000) Pathophysiology of septic encephalopathy: a review. Crit Care Med 28:3019–3024
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377
Schmidt B, Czosnyka M, Raabe A, Yahya H, Schwarze JJ, Sackerer D, Sander D, Klingelhofer J (2003) Adaptive noninva-sive assessment of intracranial pressure and cerebral autoregulation. Stroke 34:84–89
Sharshar T, Annane D, de la Grandmaison GL, Brouland JP, Hopkinson NS, Francoise G (2004) The neuropathology of septic shock. Brain Pathol 14:21–33
Sharshar T, Carlier R, Bernard F, Guidoux C, Brouland JP, Nardi O, de la Grandmaison GL, Aboab J, Gray F, Menon D, Annane D (2007) Brain lesions in septic shock: a magnetic resonance imaging study. Intensive Care Med 33:798–806
Smielewski P, Czosnyka M, Steiner L, Belestri M, Piechnik S, Pickard JD (2005) ICM+: software for on-line analysis of bedside monitoring data after severe head trauma. Acta Neurochir Suppl 95:43–49
Sprung CL, Peduzzi PN, Shatney CH, Schein RM, Wilson MF, Sheagren JN, Hinshaw LB (1990) Impact of encephalopathy on mortality in the sepsis syndrome. The Veterans Administration Systemic Sepsis Cooperative Study Group. Crit Care Med 18:801–806
Stocchetti N (2005) Brain and sepsis: functional impairment, structural damage, and markers. Anesth Analg 101:1463–1464
Talvik R, Liigant A, Tapfer H, Tamme K, Metsvaht T (1998) Septic shock with disseminated microfoci in multiple organs in humans. Intensive Care Med 24:73–76
Author information
Authors and Affiliations
Editor information
Rights and permissions
Copyright information
© 2008 Springer-Verlag/Wien
About this paper
Cite this paper
Pfister, D. et al. (2008). Intracranial pressure in patients with sepsis. In: Steiger, H.J. (eds) Acta Neurochirurgica Supplements. Acta Neurochirurgica Supplementum, vol 102. Springer, Vienna. https://doi.org/10.1007/978-3-211-85578-2_14
Download citation
DOI: https://doi.org/10.1007/978-3-211-85578-2_14
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-85577-5
Online ISBN: 978-3-211-85578-2
eBook Packages: MedicineMedicine (R0)