Clin Physiol Funct Imaging (2015)
doi: 10.1111/cpf.12256
Dynamic cerebral autoregulation to induced blood pressure changes in human experimental and clinical sepsis Ronan M. G. Berg1,2, Ronni R. Plovsing3,4, Damian M. Bailey5, Niels-Henrik Holstein-Rathlou6 and Kirsten Møller2,7 1
Department of Clinical Physiology, Nuclear Medicine & PET, University Hospital Rigshospitalet, 2Centre of Inflammation and Metabolism, Department of Infectious Diseases M7641, University Hospital Rigshospitalet, 3Department of Intensive Care, University Hospital Rigshospitalet, Copenhagen Ø, 4Department of Anaesthesia, Køge Hospital, Køge, Denmark, 5Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Wales, UK, 6 Renal and Vascular Research Section, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, and 7Neurointensive Care Unit 2093, Department of Neuroanaesthesiology, University Hospital Rigshospitalet, Copenhagen Ø, Denmark
Summary Correspondence Ronan M. G. Berg, Department of Clinical Physiology, Nuclear Medicine & PET, University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark E-mail: [email protected]
Accepted for publication Received 25 October 2014; accepted 24 March 2015
Key words cerebral blood flow; endotoxin; lipopolysaccharide; rate of regulation; sepsis-associated encephalopathy
Previous studies have demonstrated that dynamic cerebral autoregulation to spontaneous fluctuations in blood pressure is enhanced following lipopolysaccharide (LPS) infusion, a human experimental model of early sepsis, whereas by contrast it is impaired in patients with severe sepsis or septic shock. In this study, we hypothesized that this pattern of response would be identical during induced changes in blood pressure. Dynamic cerebral autoregulation was assessed in nine healthy volunteers and six septic patients. The healthy volunteers underwent a 4-h intravenous infusion of LPS (total dose: 2 ng kg1). Mean arterial blood pressure (MAP, arterial transducer) and middle cerebral artery blood flow velocity (MCAv, transcranial Doppler ultrasound) were recorded continuously during thigh-cuff deflation-induced changes in MAP for the determination of a modified rate of regulation (RoR). This was performed before and after LPS infusion in healthy volunteers, and within 72 h following clinical diagnosis of sepsis in patients. In healthy volunteers, thigh-cuff deflation caused a MAP reduction of 16 (13–20) % at baseline and 18 (16–20) % after LPS, while the MAP reduction was 12 (11– 13) % in patients (P
doi: 10.1111/cpf.12256
Dynamic cerebral autoregulation to induced blood pressure changes in human experimental and clinical sepsis Ronan M. G. Berg1,2, Ronni R. Plovsing3,4, Damian M. Bailey5, Niels-Henrik Holstein-Rathlou6 and Kirsten Møller2,7 1
Department of Clinical Physiology, Nuclear Medicine & PET, University Hospital Rigshospitalet, 2Centre of Inflammation and Metabolism, Department of Infectious Diseases M7641, University Hospital Rigshospitalet, 3Department of Intensive Care, University Hospital Rigshospitalet, Copenhagen Ø, 4Department of Anaesthesia, Køge Hospital, Køge, Denmark, 5Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Wales, UK, 6 Renal and Vascular Research Section, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, and 7Neurointensive Care Unit 2093, Department of Neuroanaesthesiology, University Hospital Rigshospitalet, Copenhagen Ø, Denmark
Summary Correspondence Ronan M. G. Berg, Department of Clinical Physiology, Nuclear Medicine & PET, University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark E-mail: [email protected]
Accepted for publication Received 25 October 2014; accepted 24 March 2015
Key words cerebral blood flow; endotoxin; lipopolysaccharide; rate of regulation; sepsis-associated encephalopathy
Previous studies have demonstrated that dynamic cerebral autoregulation to spontaneous fluctuations in blood pressure is enhanced following lipopolysaccharide (LPS) infusion, a human experimental model of early sepsis, whereas by contrast it is impaired in patients with severe sepsis or septic shock. In this study, we hypothesized that this pattern of response would be identical during induced changes in blood pressure. Dynamic cerebral autoregulation was assessed in nine healthy volunteers and six septic patients. The healthy volunteers underwent a 4-h intravenous infusion of LPS (total dose: 2 ng kg1). Mean arterial blood pressure (MAP, arterial transducer) and middle cerebral artery blood flow velocity (MCAv, transcranial Doppler ultrasound) were recorded continuously during thigh-cuff deflation-induced changes in MAP for the determination of a modified rate of regulation (RoR). This was performed before and after LPS infusion in healthy volunteers, and within 72 h following clinical diagnosis of sepsis in patients. In healthy volunteers, thigh-cuff deflation caused a MAP reduction of 16 (13–20) % at baseline and 18 (16–20) % after LPS, while the MAP reduction was 12 (11– 13) % in patients (P
