The brain as an end organ in sepsis?

Thesis event information

Date and time of the thesis defence

Place of the thesis defence

Auditorium 3 of Oulu University Hospital

Topic of the dissertation

The brain as an end organ in sepsis?

Doctoral candidate

M.D. Kristo Erikson

Faculty and unit

University of Oulu Graduate School, Faculty of Medicine, Research Group of Surgery, Anesthesiology and Intensive Care Medicine

Subject of study

Intensive care medicine

Opponent

Docent Tarja Randell, Helsinki University Hospital

Custos

Professor Tero Ala-Kokko, Oulu University Hospital

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The brain as an end organ in sepsis?

In conclusion, retinal angiography detects disturbances in retinal blood flow and retinal microaneurysms in septic shock patients. S-100β concentration could be used in the diagnosis of delirium in sepsis. The blood brain barrier damage in sepsis is related to severe organ dysfunction and systemic inflammation. Offline calculation of the C-Trend® index might offer an objective method for sleep evaluation in patients with delirium.

Delirium in intensive care is the main manifestation of sepsis-associated encephalopathy. In sepsis, the brain acts as both a mediator of the immune response and as a target organ. Our aim was to evaluate sepsis-induced changes in the brain.

In study I, retinal arterial filling time (RAFT) was measured in septic patients. Of 31 patients, 93% were in septic shock, 71% developed delirium, and 51.6% had retinal angiopathies. Patients with prolonged RAFT had a lower cardiac index before and during angiography, and more frequently had retinal abnormalities. Patients with prolonged RAFT had lower C-reactive protein and interleukin-6 levels than those with shorter RAFT.

Study II included 22 patients with septic shock, who were assessed by CAM-ICU for the presence of delirium. Delirium was associated with an elevated protein S-100β concentration and with more severe organ dysfunction during the ICU stay.

Study III examined adult patients deceased due to sepsis on the ICU. Patients were categorized as having blood-brain barrier (BBB) damage if there was no expression of occludin in the endothelium of cerebral microvessels. A damaged BBB was related to severe organ dysfunction and systemic inflammation.

In Study IV, an overnight electroencephalogram (EEG) was recorded in ICU patients with hyperactive delirium and receiving dexmedetomidine. Night-time slow-wave activity in an EEG was evaluated with an offline calculation of the C-Trend® index. Both the EEG and clinical evaluation showed that the quality and depth of night-time sleep were poor in most patients with hyperactive delirium.
Last updated: 14.3.2022