Brain Ultrasonography in Critically Ill Septic Patients: A Scoping Review

Abstract

Sepsis-associated encephalopathy (SAE) is linked to high mortality and impaired neurologic outcome. Brain ultrasonography (US) is a non-invasive tool for cerebral monitoring. A scoping review of the literature in three databases was performed to answer if brain perfusion is altered in sepsis, to determine the role of brain US in guiding resuscitation and its ability to predict the outcome. Randomized controlled trials, clinical trials, observational studies, and systematic reviews on adults with sepsis or septic shock in the ICU were included. A total of 625 articles were screened, and 34 included. There were 85% observational studies and 15% systematic reviews with or without meta-analysis. The majority of studies had a small sample size and used different metrics. The studies focused on cerebral blood flow (CBF) alterations reporting variable results (CBF increased, normal, or decreased). The findings showed a variable rate of cerebral autoregulation (CAR) impairment, with higher incidence in the early stages of sepsis and associations with poor neurological outcomes. However, the impact of CAR and CBF alterations on neurological outcomes and mortality was not clear. Very few studies were found on resuscitation. In conclusion, brain US can identify cerebral perfusions alterations and its usage in sepsis is promising. However, the current body of evidence for its usage is poor and lacks standardization.

Keywords: POCUS; TCCS; brain ultrasound; multimodal monitoring; sepsis; transcranial doppler.

Figure 1

A quorum flowchart for articles selection.