Department of Anesthesiology, Pharmacology and Therapeutics, 8166University of British Columbia, Vancouver, British Columbia, Canada.
Department of Critical Care Medicine, 4257Queen's University, Kingston, Ontario, Canada.
J Intensive Care Med. 2022 Mar;37(3):408-422. doi: 10.1177/0885066621997090. Epub 2021 Mar 9.
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.
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.
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.
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, MAP), in order to fully assess the relationship between cerebral perfusion and delirium in patients with sepsis.
几项研究先前报告了脓毒症期间脑灌注改变的存在。然而，在脓毒症伴谵妄的患者中，神经监测的作用以及脑灌注改变的影响仍不清楚。
我们对使用近红外光谱（NIRS）和/或经颅多普勒（TCD）评估成人（≥18 岁）脓毒症和谵妄的研究进行了系统评价。从研究开始到 2020 年 7 月 28 日，我们检索了以下数据库：Ovid MedLine、Embase、Cochrane 图书馆和 Web of Science。
在 1546 篇文章中，有 10 篇符合我们的纳入标准。尽管 NIRS 衍生的区域性脑氧合始终较低，但只有一项研究的差异具有统计学意义。TCD 衍生的脑血流速度在研究之间不一致。重要的是，脓毒症期间脑自动调节受损和脑血管阻力增加都与脓毒症期间的谵妄有关。然而，NIRS 和 TCD 设备的异质性、记录时间（从 10 秒到 72 小时）以及谵妄评估方法（例如，电子病历、重症监护病房意识模糊评估方法）妨碍了荟萃分析。
现有文献表明，脑灌注障碍可能与脓毒症患者的谵妄有关。然而，未来的研究需要对谵妄有一致的定义、对谵妄评估进行培训、协调 NIRS 和 TCD 评估（例如，一致的测量部位和记录长度），以及量化次要和三级变量（即，Cox、Mxa、MAP），以便充分评估脓毒症患者脑灌注与谵妄之间的关系。
