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Heming N, Mazeraud A, Azabou E, et al. Vasopressor Therapy and the Brain: Dark Side of the Moon. Front Med (Lausanne). 2020;6:317doi: 10.3389/fmed.2019.00317.
Heming, N., Mazeraud, A., Azabou, E., Moine, P., & Annane, D. (2019). Vasopressor Therapy and the Brain: Dark Side of the Moon. Frontiers in medicine, 6317. https://doi.org/10.3389/fmed.2019.00317
Heming, Nicholas, et al. "Vasopressor Therapy and the Brain: Dark Side of the Moon." Frontiers in medicine vol. 6 (2019): 317. doi: https://doi.org/10.3389/fmed.2019.00317
Heming N, Mazeraud A, Azabou E, Moine P, Annane D. Vasopressor Therapy and the Brain: Dark Side of the Moon. Front Med (Lausanne). 2020 Jan 10;6:317. doi: 10.3389/fmed.2019.00317. eCollection 2019. PMID: 31998736; PMCID: PMC6966606.
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Front Med (Lausanne). 2020 Jan 10;6:317. doi: 10.3389/fmed.2019.00317. eCollection 2019.

Vasopressor Therapy and the Brain: Dark Side of the Moon.

Frontiers in medicine

Nicholas Heming, Aurélien Mazeraud, Eric Azabou, Pierre Moine, Djillali Annane

Affiliations

  1. General Intensive Care Unit, Raymond Poincaré Hospital, Garches, France.
  2. U1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, France.
  3. Department of Neuro-Anesthesiology and Intensive Care Medicine, Sainte-Anne Teaching Hospital, Paris-Descartes University, Paris, France.
  4. Department of Physiology, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, Garches, France.

PMID: 31998736 PMCID: PMC6966606 DOI: 10.3389/fmed.2019.00317

Abstract

Sepsis, a leading cause of morbidity and mortality, is caused by a deregulated host response to pathogens, and subsequent life-threatening organ dysfunctions. All major systems, including the cardiovascular, respiratory, renal, hepatic, hematological, and the neurological system may be affected by sepsis. Sepsis associated neurological dysfunction is triggered by multiple factors including neuro-inflammation, excitotoxicity, and ischemia. Ischemia results from reduced cerebral blood flow, caused by extreme variations of blood pressure, occlusion of cerebral vessels, or more subtle defects of the microcirculation. International guidelines comprehensively describe the initial hemodynamic management of sepsis, revolving around the normalization of systemic hemodynamics and of arterial lactate. By contrast, the management of sepsis patients suffering from brain dysfunction is poorly detailed, the only salient point being mentioned is that sedation and analgesia should be optimized. However, sepsis and the hemodynamic consequences thereof as well as vasopressors may have severe untoward neurological consequences. The current review describes the general neurological complications, as well as the consequences of vasopressor therapy on the brain and its circulation and addresses methods for cerebral monitoring during sepsis.

Copyright © 2020 Heming, Mazeraud, Azabou, Moine and Annane.

Keywords: coma; delirium; sepsis; sepsis associated encephalopathy; septic shock

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