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Brain Tissue Oxygenation in Patients with Septic Shock: a Feasibility Study

  • Michael Wood (a1), Andy Song (a2), David Maslove (a3), Cathy Ferri (a2), Daniel Howes (a2) (a3), John Muscedere (a3) and J Gordon Boyd (a1) (a3) (a4)...

Abstract

Background: Delirium is common in critically ill patients and its presence is associated with increased mortality and increased likelihood of poor cognitive function among survivors. However, the cause of delirium is unknown. The purpose of this study was to demonstrate the feasibility of using near-infrared spectroscopy (NIRS) to assess brain tissue oxygenation in patients with septic shock, who are at high risk of developing delirium. Methods : This prospective observational study was conducted in a 33-bed general medical surgical intensive care unit (ICU). Patients with severe sepsis or septic shock were eligible for recruitment. The FORESIGHT NIRS monitor was used to assess brain tissue oxygenation in the frontal lobes for the first 72 hours of ICU admission. Physiological data was also recorded. We used the Confusion Assessment Method-ICU to screen for delirium. Results : From March 1st 2014-September 30th 2014, 10 patients with septic shock were recruited. The NIRS monitor captured 81% of the available data. No adverse events were recorded. Brain tissue oxygenation demonstrated significant intra- and inter-individual variability in the way it correlated with physiological parameters, such as mean arterial pressure, heart rate, and peripheral oxygen saturation. Mean brain tissue oxygen levels were significantly lower in patients who were delirious for the majority of their ICU stay. Conclusion: It is feasible to record brain tissue oxygenation with NIRS in patients with septic shock. This study provides the infrastructure necessary for a larger prospective observational study to further examine the relationship between brain tissue oxygenation, physiological parameters, and acute neurological dysfunction.

Oxygénation tissulaire cérébrale chez les patients atteints de choc septique : une étude de faisabilité. Contexte : Le délire est fréquent chez les patients qui sont gravement malades et sa présence est associée à une mortalité accrue ainsi qu’à une probabilité accrue d’altération de la fonction cognitive chez les survivants. Cependant, la cause du délire demeure inconnue. Le but de cette étude était de démontrer la faisabilité d’utiliser la spectroscopie proche infrarouge (NIRS) pour évaluer l’oxygénation du tissu cérébral chez des patients en choc septique qui sont à haut risque de présenter un délire. Méthode : Nous avons effectué une étude observationnelle prospective dans une unité de soins intensifs (USI) médicaux et chirurgicaux de 33 lits. Les patients atteints de septicémie sévère ou de choc septique étaient éligibles à l’étude. Un moniteur FORESIGHT NIRS a été utilisé pour évaluer l’oxygénation du tissu cérébral des lobes frontaux au cours des 72 premières heures d’hospitalisation à l’USI. Nous avons recueilli les données physiologiques. Le Confusion Assessment Method-ICU a été utilisé pour dépister le délire. Résultats : Dix patients atteints de choc septique entre le 1er mars 2014 et le 30 septembre 2014 ont été inclus dans l’étude. Le moniteur NIRS a capté 81% des données disponibles. Aucun incident fâcheux n’a été observé. Nous avons noté une grande variabilité intra et inter individu dans la corrélation entre l’oxygénation du tissu cérébral et les paramètres physiologiques comme la tension artérielle, le rythme cardiaque et la saturation périphérique en oxygène. Les niveaux d’oxygène du tissu cérébral étaient significativement inférieurs chez les patients qui étaient en délire pendant la plus grande partie de leur séjour à l’USI. Conclusion : Il est possible d’enregistrer l’oxygénation du tissu cérébral avec le NIRS chez des patients en choc septique. Cette étude indique quelle est l’infrastructure requise pour une étude observationnelle prospective de plus grande ampleur dans le but d’examiner davantage la relation entre l’oxygénation du tissu cérébral, les paramètres physiologiques et la dysfonction neurologique aiguë.

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Copyright

Corresponding author

Correspondence to: J. Gordon Boyd, Department of Medicine (Neurology) and Critical Care, Centre for Neuroscience Studies, Queen’s University, Davies 2, Kingston General Hospital, 76 Stuart St. Kingston, ON, Canada, K7L 2V7. Email: john.gordon.boyd@queensu.ca

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