Vasopressor Therapy and the Brain: Dark Side of the Moon

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 s...

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Main Authors: Nicholas Heming, Aurélien Mazeraud, Eric Azabou, Pierre Moine, Djillali Annane
Format: Article
Language:English
Published: Frontiers Media S.A. 2020-01-01
Series:Frontiers in Medicine
Subjects:
Online Access:https://www.frontiersin.org/article/10.3389/fmed.2019.00317/full
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spelling doaj-cee288484c4d49fdb61a68c971049e762020-11-24T21:22:24ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2020-01-01610.3389/fmed.2019.00317500391Vasopressor Therapy and the Brain: Dark Side of the MoonNicholas Heming0Nicholas Heming1Aurélien Mazeraud2Eric Azabou3Eric Azabou4Pierre Moine5Pierre Moine6Djillali Annane7Djillali Annane8General Intensive Care Unit, Raymond Poincaré Hospital, Garches, FranceU1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, FranceDepartment of Neuro-Anesthesiology and Intensive Care Medicine, Sainte-Anne Teaching Hospital, Paris-Descartes University, Paris, FranceU1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, FranceDepartment of Physiology, Assistance Publique-Hôpitaux de Paris, Raymond-Poincaré Hospital, Garches, FranceGeneral Intensive Care Unit, Raymond Poincaré Hospital, Garches, FranceU1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, FranceGeneral Intensive Care Unit, Raymond Poincaré Hospital, Garches, FranceU1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, FranceSepsis, 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.https://www.frontiersin.org/article/10.3389/fmed.2019.00317/fullsepsis associated encephalopathydeliriumcomasepsisseptic shock
collection DOAJ
language English
format Article
sources DOAJ
author Nicholas Heming
Nicholas Heming
Aurélien Mazeraud
Eric Azabou
Eric Azabou
Pierre Moine
Pierre Moine
Djillali Annane
Djillali Annane
spellingShingle Nicholas Heming
Nicholas Heming
Aurélien Mazeraud
Eric Azabou
Eric Azabou
Pierre Moine
Pierre Moine
Djillali Annane
Djillali Annane
Vasopressor Therapy and the Brain: Dark Side of the Moon
Frontiers in Medicine
sepsis associated encephalopathy
delirium
coma
sepsis
septic shock
author_facet Nicholas Heming
Nicholas Heming
Aurélien Mazeraud
Eric Azabou
Eric Azabou
Pierre Moine
Pierre Moine
Djillali Annane
Djillali Annane
author_sort Nicholas Heming
title Vasopressor Therapy and the Brain: Dark Side of the Moon
title_short Vasopressor Therapy and the Brain: Dark Side of the Moon
title_full Vasopressor Therapy and the Brain: Dark Side of the Moon
title_fullStr Vasopressor Therapy and the Brain: Dark Side of the Moon
title_full_unstemmed Vasopressor Therapy and the Brain: Dark Side of the Moon
title_sort vasopressor therapy and the brain: dark side of the moon
publisher Frontiers Media S.A.
series Frontiers in Medicine
issn 2296-858X
publishDate 2020-01-01
description 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.
topic sepsis associated encephalopathy
delirium
coma
sepsis
septic shock
url https://www.frontiersin.org/article/10.3389/fmed.2019.00317/full
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