Cucciolini, G.; Corda, I.; Forfori, F.; Corradi, F. Brain Ultrasonography in Critically Ill Septic Patients: A Scoping Review. Preprints2024, 2024090389. https://doi.org/10.20944/preprints202409.0389.v1
APA Style
Cucciolini, G., Corda, I., Forfori, F., & Corradi, F. (2024). Brain Ultrasonography in Critically Ill Septic Patients: A Scoping Review. Preprints. https://doi.org/10.20944/preprints202409.0389.v1
Chicago/Turabian Style
Cucciolini, G., Francesco Forfori and Francesco Corradi. 2024 "Brain Ultrasonography in Critically Ill Septic Patients: A Scoping Review" Preprints. https://doi.org/10.20944/preprints202409.0389.v1
Abstract
Introduction
Sepsis-associated encephalopathy (SAE) is common in sepsis and is linked to high mortality and impaired neurologic outcome. Brain ultrasonography (US), including transcranial Doppler (TCD) and transcranial color-coded duplex sonography (TCCS), is a non-invasive tool for cerebral monitoring and might be useful in sepsis. The aims of this review are: 1) to explore whether brain perfusion is altered in sepsis, 2) to determine the role of brain US in guiding resuscitation, and 3) its ability to predict neurological outcomes in septic patients.
Materials and methods
This scoping review adhered to the PRISMA-ScR protocol and JBI methodology. A comprehensive literature search was conducted across MEDLINE, Scopus, and Web of Science. The review included studies on adults with sepsis or septic shock in the ICU. Randomised controlled trials, clinical trials, observational studies and systematic reviews were included. All the data related to the review's key questions were extracted and charted independently by two authors.
Results
625 articles were screened, and 34 were ultimately included after application of exclusion criteria. 85% of the studies were observational 15% were systematic reviews with or without meta-analysis. The studies primarily focused on cerebral blood flow (CBF) alterations in sepsis, reporting variable results. Findings showed variable cerebral autoregulation (CAR) impairment, with higher incidence in the early stages of sepsis and associations with poor neurological outcomes. However, while alterations in CAR and CBF are common in septic patients, their impact on neurological outcomes and mortality is not clear. Regarding resuscitation, only a paucity of studies were found and no conclusions can be drawn.
Conclusions
The current body of evidence has a poor grade, but it is possible to say that brain US can identify cerebral perfusions alterations. Its usage during resuscitation is feasible and warrants further investigations. Use of brain US during resuscitation and for prediction of outcome is not currently supported by evidence. Further studies on brain perfusion, acquisition of 2D images of parenchyma (TCCS) and application of a multimodal brain monitoring might be useful in these contexts.
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
