Transcranial doppler assessment of cerebral perfusion in critically ill septic patients: a pilot study

Background: The aim of this study is to evaluate the feasibility and efficacy of Transcranial Doppler (TCD) in assessing cerebral perfusion changes in septic patients. Methods: Using TCD, we measured the mean velocity in the middle cerebral artery (VmMCA, cm/sec) and calculated the pulsatility index (PI), resistance index (RI) and cerebral blood flow index (CBFi = 10*MAP/1.47(PI)) on the first day of patients' admission or on the first day of sepsis development; measurements were repeated on the second day. Sepsis was defined according to standard criteria. Results: Forty-one patients without any known neurologic deficit treated in our 24-bed Critical Care Unit were assessed (Sepsis Group = 20, Control Group = 21). Examination was feasible in 91% of septic and 85% of non-septic patients (p = 0.89). No difference was found between the two groups in mean age, mean arterial pressure (MAP) or APACHE II score. The pCO(2) values were higher in septic patients (46 +/- 12 vs. 39 +/- 4 mmHg p < 0.01). No statistically significant higher values of VmMCA were found in septic patients (110 +/- 34 cm/sec vs. 99 +/- 28 cm/sec p = 0.17). Higher values of PI and RI were found in septic patients (1.15 +/- 0.25 vs. 0.98 +/- 0.16 p < 0.01, 0.64 +/- 0.08 vs. 0.59 +/- 0.06 p < 0.01, respectively). No statistically significant lower values of CBFi were found in septic patients (497 +/- 116 vs. 548 +/- 110 p = 0.06). Conclusions: Our results suggest cerebral vasoconstriction in septic compared to non-septic patients. TCD is an efficient and feasible exam to evaluate changes in cerebral perfusion during sepsis.