The spectrum of sepsis-associated encephalopathy: a clinical perspective

作者：Romain Sonneville, Sarah Benghanem, Lina Jeantin, Étienne de Montmollin, Marc Doman, Augustin Gaudemer, Michaël Thy, Jean‐François Timsit · 发表于：Critical Care · 年份：2023 · DOI：10.1186/s13054-023-04655-8 · 被引用次数：189 · 研究领域：Intensive Care Unit Cognitive Disorders、Traumatic Brain Injury and Neurovascular Disturbances、Sepsis Diagnosis and Treatment

Sepsis-associated encephalopathy is a severe neurologic syndrome characterized by a diffuse dysfunction of the brain caused by sepsis. This review provides a concise overview of diagnostic tools and management strategies for SAE at the acute phase and in the long term. Early recognition and diagnosis of SAE are crucial for effective management. Because neurologic evaluation can be confounded by several factors in the intensive care unit setting, a multimodal approach is warranted for diagnosis and management. Diagnostic tools commonly employed include clinical evaluation, metabolic tests, electroencephalography, and neuroimaging in selected cases. The usefulness of blood biomarkers of brain injury for diagnosis remains limited. Clinical evaluation involves assessing the patient's mental status, motor responses, brainstem reflexes, and presence of abnormal movements. Electroencephalography can rule out non-convulsive seizures and help detect several patterns of various severity such as generalized slowing, epileptiform discharges, and triphasic waves. In patients with acute encephalopathy, the diagnostic value of non-contrast computed tomography is limited. In septic patients with persistent encephalopathy, seizures, and/or focal signs, magnetic resonance imaging detects brain injury in more than 50% of cases, mainly cerebrovascular complications, and white matter changes. Timely identification and treatment of the underlying infection are paramount, along with effective contr...