British Journal of Anaesthesia, Vol 76, Issue 6 790-794, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
B. F. Matta and P. J. Stow
We have studied cerebral autoregulation and vasoreactivity to carbon
dioxide in 10 patients with the sepsis syndrome receiving intensive
therapy. All patients were sedated with infusions of midazolam and
fentanyl, and their lungs were ventilated mechanically with oxygen-air to
maintain normoxia and normocapnia. Inotropic support and antibiotics were
administered as necessary. During a period of constant level of sedation
and stable haemodynamics, cerebral autoregulation was tested by increasing
mean arterial pressure (MAP) by 23 (SD 2) mm Hg from baseline with an
infusion of phenylephrine and simultaneously recording middle cerebral
artery blood flow velocity (vmca) using transcranial Doppler
ultrasonography. Carbon dioxide reactivity was tested by varying PaCO2
between 3.0 and 7.0 kPa and simultaneously recording vmca. There was no
significant change in vmca (57 (22) and 59 (23) cm s- 1) during the
increase in MAP (75 (11) to 98 (10) mm Hg). The mean index of
autoregulation (IOR) was 0.92 (SEM 0.03), which was not significantly
different from 1, indicating near perfect autoregulation. Although absolute
carbon dioxide reactivity was lower than reported previously in awake
subjects, relative carbon dioxide reactivity was within normal limits for
all patients (11.6 (SEM 0.8) cm s-1 and 20.3 (3) % kPa-1, respectively). We
conclude that cerebral carbon dioxide reactivity and pressure
autoregulation remained intact in patients with the sepsis syndrome,
providing indirect evidence that at least in the early stages of the
syndrome, the widespread sepsis-induced vasoparalysis does not involve the
cerebral vasculature.
CLINICAL INVESTIGATIONS
Sepsis-induced vasoparalysis does not involve the cerebral vasculature: indirect evidence from autoregulation and carbon dioxide reactivity studies
Department of Anaesthesia, Ipswich Hospital, Heath Road, Ipswich, Suffolk IP4 5PD
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