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      Effects of short-term mechanical hyperventilation on cerebral blood flow and dynamic cerebral autoregulation in critically ill patients with sepsis.

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          Abstract

          In sepsis, higher PaCO2 levels are associated with impaired dynamic cerebral autoregulation (dCA), which may expose the brain to hypo- and hyperperfusion during acute fluctuations in blood pressure. We hypothesised that short-term mechanical hyperventilation would dCA in critically ill patients with sepsis. Seven mechanically ventilated septic patients were included. We assessed dCA before and after 30 min of mechanical hyperventilation. Transfer function analysis of spontaneous oscillations in transcranial Doppler-based middle cerebral artery blood flow velocity (MCAv) and invasive mean arterial blood pressure was used to assess dCA. Mechanical enhance hyperventilation reduced the median PaCO2 from 5.3 (IQR, 5.0-6.5) to 4.7 (IQR, 4.2-5.1) kPa (p < 0.05). This was associated with a reduction in the median MCAv from 57 (IQR, 33-68) to 32 (IQR, 21-40) cm sec(-1) (p < 0.05). Apart from a small increase in gain in the low frequency range (2.32 [IQR 1.80-2.41] vs. 2.59 (2.40-4.64) cm mmHg(-1) sec(-1); p < 0.05), this was not associated with any enhancement in dCA. In conclusion, cerebral CO2 vasoreactivity was found to be preserved in septic patients; nevertheless, and in contrast to our working hypothesis, short-term mechanical hyperventilation did not enhance dCA.

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          Author and article information

          Journal
          Scand J Clin Lab Invest
          Scandinavian journal of clinical and laboratory investigation
          Informa UK Limited
          1502-7686
          0036-5513
          2016
          : 76
          : 3
          Affiliations
          [1 ] a Department of Clinical Physiology and Nuclear Medicine , Bispebjerg and Frederiksberg Hospitals , Copenhagen ;
          [2 ] b Centre of Inflammation and Metabolism , University Hospital Rigshospitalet , Copenhagen ;
          [3 ] c Department of Intensive Care 4131 , University Hospital Rigshospitalet , Copenhagen ;
          [4 ] d Department of Anaesthesiology , Køge Hospital , Køge , Denmark.
          Article
          10.3109/00365513.2015.1137350
          26935607
          7a1b2c48-2c37-4868-acb7-14baaee46605
          History

          Cerebral blood flow,hyperventilation,mechanical ventilation,sepsis,sepsis-associated encephalopathy,transcranial Doppler ultrasonography

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