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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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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