1. The Use of Near-Infrared Spectroscopy and/or Transcranial Doppler as Non-Invasive Markers of Cerebral Perfusion in Adult Sepsis Patients With Delirium: A Systematic Review
- Author
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Michael D. Wood, Timothy D. Girard, J. Gordon Boyd, Nicole Wood, Donald E. G. Griesdale, Denise Foster, James Frank, Amanda Ross-White, and Akash Chopra
- Subjects
Adult ,medicine.medical_specialty ,cerebral autoregulation ,Ultrasonography, Doppler, Transcranial ,near-infrared spectroscopy ,Critical Care and Intensive Care Medicine ,Pulsatility index ,Cerebral autoregulation ,transcranial Doppler ,Sepsis ,sepsis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,pulsatility index ,030212 general & internal medicine ,Cerebral perfusion pressure ,Original Research ,Spectroscopy, Near-Infrared ,business.industry ,Non invasive ,Delirium ,medicine.disease ,Transcranial Doppler ,Cerebrovascular Circulation ,Cardiology ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Background: Several studies have previously reported the presence of altered cerebral perfusion during sepsis. However, the role of non-invasive neuromonitoring, and the impact of altered cerebral perfusion, in sepsis patients with delirium remains unclear. Methods: We performed a systematic review of studies that used near-infrared spectroscopy (NIRS) and/or transcranial Doppler (TCD) to assess adults (≥18 years) with sepsis and delirium. From study inception to July 28, 2020, we searched the following databases: Ovid MedLine, Embase, Cochrane Library, and Web of Science. Results: Of 1546 articles identified, 10 met our inclusion criteria. Although NIRS-derived regional cerebral oxygenation was consistently lower, this difference was only statistically significant in one study. TCD-derived cerebral blood flow velocity was inconsistent across studies. Importantly, both impaired cerebral autoregulation during sepsis and increased cerebrovascular resistance were associated with delirium during sepsis. However, the heterogeneity in NIRS and TCD devices, duration of recording (from 10 seconds to 72 hours), and delirium assessment methods (e.g., electronic medical records, confusion assessment method for the intensive care unit), precluded meta-analysis. Conclusion: The available literature demonstrates that cerebral perfusion disturbances may be associated with delirium in sepsis. However, future investigations will require consistent definitions of delirium, delirium assessment training, harmonized NIRS and TCD assessments (e.g., consistent measurement site and length of recording), as well as the quantification of secondary and tertiary variables (i.e., Cox, Mxa, MAPOPT), in order to fully assess the relationship between cerebral perfusion and delirium in patients with sepsis.
- Published
- 2021