Evaluating cerebral perfusion changes with transcranial doppler ultrasound in patients diagnosed with sepsis

Sepsis related brain dysfunction (SRBD) affects more than 70% of patients with sepsis diagnosis. Delay in SRBD diagnosis increases the risk of sepsis related encephalopathy and neurological sequelae. Transcranial Doppler (TCD) is one of the non-interventional, bedside methods which helps to evaluate cerebral blood flow. We aimed to observe the changes in the blood flow of the middle cerebral artery of septic patients by measuring the Pulsatility, Resistance indexes (P.I, R.I) and CBF index at 0, 6, 24, and 48 hours prospectively. After ethics committee approval, 47 patients diagnosed with sepsis and hospitalized in Bursa Uludag University, Intensive Care unit were included in the study. Patients' demographic information, comorbidities, sequential organ failure assessment, acute physiology and chronic health evaluation scores, mean arterial blood pressure, mechanical ventilation support, positive end-expiratory pressure, intensive care duration of stay, vasoactive and sedoanalgesic drugs, renal replacement therapy, total fluid amount, C-reactive protein, glucose, PH, partial oxygen and carbon dioxide pressure, peripheral oxygen saturation, P/F ratio, lactate, Glasgow coma scale, urea, sodium, heamogram data and P.I, R.I and CBFi values we collected. When the group that received vasoactive drugs and the group that did not take were combined; statistically significant difference was found in P.I values at the 48th hour compared to the baseline. Also, there was statistically significant difference at R.I values of the patients who received sedoanalgesic drugs at the 6th hour compared to baseline (p <0.05). When parameters such as partial oxygen, carbon dioxide pressure, end-expiratory positive pressure, sodium, glucose, Lactate, mean arterial blood pressure, hemoglobin, which can cause cerebrovascular circulation changes, are kept within normal ranges, Cerebrovascular resistance and perfusion indicators such as P.I, R.I and CBFi shows minimal changes. Further studies are required to evaluate the role of TCD to guide therapies in septic patients.