Абстрактный

Electroencephalogram and cerebral hemodynamic monitoring in pediatric patients with sepsis and septic shock.

Hanan M Ibrahim Youssef, Mervat Gamal El-Din Mansour, Iman Ali Abdel Hamid Elagouza, Hossam Moussa El Sayed Sakr, Ahmed Rezk Ahmed Rezk, Samuel Noshy Azer Beshay*

Introduction: Sepsis-Associated Brain Dysfunction (SABD) is a potentially fatal but treatable mental impairment induced by underlying sepsis that is related to impaired cerebral auto regulation, leading to cerebral hypo or hyper perfusion. The present study attempted to monitor the cerebral hemodynamics as well as Electro Encephalon Gram (EEG) findings in pediatric patients suffering from sepsis and septic shock. Methods: The current case-control study recruited 56 children hospitalized to the PICU with septic shock or sepsis. Trans cranial Doppler parameters (Resistive Index (RI), Plasticity Index (PI), median Velocity in Middle Cerebral Artery (mVMCA), Vasomotor Reactivity (VMR) and Cerebral Blood Flow Index (CBFi) were assessed daily, along with a daily 10-minutes EEG recording for the predominant brain electrical activity during the first four days of admission. Results: The study comprised 20 children with sepsis, 16 with septic shock and 20 age and sex matched non-septic critical children (pSOFA score 3.2 ± 2.1, 7.3 ± 3.9, and 0.5 ± 1.1 respectively). Compared to control and sepsis groups, patients with septic shock had a significant increase in PI, mVMCA, and CBFi at hours 48 and 72 of enrollment, while cerebral VMR was disturbed at hours 24 and 48? RI remained unchanged in septic shock patients. Excessive theta waves were the most prominent EEG pattern in the first 24-48 hours in septic shock patients, followed by burst suppression at hour 72. Conclusion: Most patients with septic shock experienced impaired cerebral vasomotor reactivity and EEG changes in the first two days that precede changes in PI and CBFi.