Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 May 18;56(5):240.
doi: 10.3390/medicina56050240.

Sepsis Associated Delirium

Ben Atterton  1 , Maria Carolina Paulino  2 , Pedro Povoa  2   3   4 , Ignacio Martin-Loeches  1   5
Affiliations
Review

Sepsis Associated Delirium

Ben Atterton et al. Medicina (Kaunas). .

Abstract

Sepsis is a potentially life-threatening condition caused by a systemic dysregulated host response to infection. The brain is particularly susceptible to the effects of sepsis with clinical manifestations ranging from mild confusion to a deep comatose state. Sepsis-associated delirium (SAD) is a cerebral manifestation commonly occurring in patients with sepsis and is thought to occur due to a combination of neuroinflammation and disturbances in cerebral perfusion, the blood brain barrier (BBB) and neurotransmission. The neurological impairment associated with SAD can persist for months or even longer, after the initial septic episode has subsided which may impair the rehabilitation potential of sepsis survivors. Early identification and treatment of the underlying sepsis is key in the management of SAD as once present it can be difficult to control. Through the regular use of validated screening tools for delirium, cases of SAD can be identified early; this allows potentially aggravating factors to be addressed promptly. The usefulness of biomarkers, neuroimaging and electroencephalopathy (EEG) in the diagnosis of SAD remains controversial. The Society of Critical Care Medicine (SCCM) guidelines advise against the use of medications to treat delirium unless distressing symptoms are present or it is hindering the patient's ability to wean from organ support.

Keywords: ICU; delirium; dexmedetomidine; sepsis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Investigation and Management of sepsis-associated delirium (SAD).
Figure 2
Figure 2
ABCDEF bundle.
See this image and copyright information in PMC

References

    1. Annane D., Sharshar T. Cognitive decline after sepsis. Lancet Respir. Med. 2015;3:61–69. doi: 10.1016/S2213-2600(14)70246-2. - DOI - PubMed
    1. Wijdicks E.F., Stevens M. The role of hypotension in septic encephalopathy following surgical procedures. Arch. Neurol. 1992;49:653–656. doi: 10.1001/archneur.1992.00530300093015. - DOI - PubMed
    1. Janz D.R., Abel T.W., Jackson J.C., Gunther M.L., Heckers S., Ely E.W. Brain autopsy findings in intensive care unit patients previously suffering from delirium: A pilot study. J. Crit. Care. 2010;25:538.e7-12. doi: 10.1016/j.jcrc.2010.05.004. - DOI - PMC - PubMed
    1. Sharshar T., Annane D., de la Grandmaison G.L., Brouland J.P., Hopkinson N.S., Françoise G. The neuropathology of septic shock. Brain Pathol. 2004;14:21–33. doi: 10.1111/j.1750-3639.2004.tb00494.x. - DOI - PMC - PubMed
    1. Hughes C.G., Morandi A., Girard T.D., Riedel B., Thompson J.L., Shintani A.K., Pun B.T., Ely E.W., Pandharipande P.P. Association between endothelial dysfunction and acute brain dysfunction during critical illness. Anesthesiology. 2013;118:631–639. doi: 10.1097/ALN.0b013e31827bd193. - DOI - PMC - PubMed