Sepsis in the ICU: Usefulness of Transcranial Doppler (TCD/TCCS) to Cerebral Hemodynamic Monitoring

Sepsis-associated encephalopathy (SAE) is common during sepsis and is associated with poor outcome and long-term cognitive sequelae. Altered cerebral autoregulation (CA) may lead to suboptimal cerebral perfusion, which may contribute to the development of SAE. CA may be investigated by transcranial Doppler (TCD/TCCS). Modifications in cerebral circulation have been investigated in humans affected by sepsis and SAE with controversial results. Data suggest that CA may be impaired early during the course of sepsis and associated with both severity of inflammatory syndrome and neurological dysfunction. However, to date, studies investigating cerebral hemodynamics in large cohort of septic patients are lacking. Furthermore, comparability of the results in published literature is difficult because of the variety of methods in CA assessment. Whether cerebrovascular resistance and reactivity to carbon dioxide are affected during sepsis is not clear. Therapeutic strategies based on optimization of cerebral perfusion using TCD may be of interest in clinical practice.