Disassociation of static and dynamic cerebral autoregulatory performance in healthy volunteers after lipopolysaccharide infusion and in patients with sepsis
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Disassociation of static and dynamic cerebral autoregulatory performance in healthy volunteers after lipopolysaccharide infusion and in patients with sepsis. / Berg, Ronan M G; Plovsing, Ronni R; Ronit, Andreas; Bailey, Damian M; Holstein-Rathlou, Niels-Henrik; Møller, Kirsten.
In: American Journal of Physiology: Regulatory, Integrative and Comparative Physiology, Vol. 303, No. 11, 12.2012, p. R1127-35.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Disassociation of static and dynamic cerebral autoregulatory performance in healthy volunteers after lipopolysaccharide infusion and in patients with sepsis
AU - Berg, Ronan M G
AU - Plovsing, Ronni R
AU - Ronit, Andreas
AU - Bailey, Damian M
AU - Holstein-Rathlou, Niels-Henrik
AU - Møller, Kirsten
PY - 2012/12
Y1 - 2012/12
N2 - Sepsis is frequently complicated by brain dysfunction, which may be associated with disturbances in cerebral autoregulation, rendering the brain susceptible to hypoperfusion and hyperperfusion. The purpose of the present study was to assess static and dynamic cerebral autoregulation 1) in a human experimental model of the systemic inflammatory response during early sepsis and 2) in patients with advanced sepsis. Cerebral autoregulation was tested using transcranial Doppler ultrasound in healthy volunteers (n = 9) before and after LPS infusion and in patients with sepsis (n = 16). Static autoregulation was tested by norepinephrine infusion and dynamic autoregulation by transfer function analysis (TFA) of spontaneous oscillations between mean arterial blood pressure and middle cerebral artery blood flow velocity in the low frequency range (0.07-0.20 Hz). Static autoregulatory performance after LPS infusion and in patients with sepsis was similar to values in healthy volunteers at baseline. In contrast, TFA showed decreased gain and an increased phase difference between blood pressure and middle cerebral artery blood flow velocity after LPS (both P < 0.01 vs. baseline); patients exhibited similar gain but lower phase difference values (P < 0.01 vs. baseline and LPS), indicating a slower dynamic autoregulatory response. Our findings imply that static and dynamic cerebral autoregulatory performance may disassociate in sepsis; thus static autoregulation was maintained both after LPS and in patients with sepsis, whereas dynamic autoregulation was enhanced after LPS and impaired with a prolonged response time in patients. Hence, acute surges in blood pressure may adversely affect cerebral perfusion in patients with sepsis.
AB - Sepsis is frequently complicated by brain dysfunction, which may be associated with disturbances in cerebral autoregulation, rendering the brain susceptible to hypoperfusion and hyperperfusion. The purpose of the present study was to assess static and dynamic cerebral autoregulation 1) in a human experimental model of the systemic inflammatory response during early sepsis and 2) in patients with advanced sepsis. Cerebral autoregulation was tested using transcranial Doppler ultrasound in healthy volunteers (n = 9) before and after LPS infusion and in patients with sepsis (n = 16). Static autoregulation was tested by norepinephrine infusion and dynamic autoregulation by transfer function analysis (TFA) of spontaneous oscillations between mean arterial blood pressure and middle cerebral artery blood flow velocity in the low frequency range (0.07-0.20 Hz). Static autoregulatory performance after LPS infusion and in patients with sepsis was similar to values in healthy volunteers at baseline. In contrast, TFA showed decreased gain and an increased phase difference between blood pressure and middle cerebral artery blood flow velocity after LPS (both P < 0.01 vs. baseline); patients exhibited similar gain but lower phase difference values (P < 0.01 vs. baseline and LPS), indicating a slower dynamic autoregulatory response. Our findings imply that static and dynamic cerebral autoregulatory performance may disassociate in sepsis; thus static autoregulation was maintained both after LPS and in patients with sepsis, whereas dynamic autoregulation was enhanced after LPS and impaired with a prolonged response time in patients. Hence, acute surges in blood pressure may adversely affect cerebral perfusion in patients with sepsis.
KW - Adult
KW - Aged
KW - Blood Pressure/drug effects
KW - Cerebral Cortex/drug effects
KW - Female
KW - Homeostasis/drug effects
KW - Humans
KW - Infusions, Intravenous
KW - Lipopolysaccharides/administration & dosage
KW - Male
KW - Middle Aged
KW - Sepsis/physiopathology
KW - Young Adult
U2 - 10.1152/ajpregu.00242.2012
DO - 10.1152/ajpregu.00242.2012
M3 - Journal article
C2 - 23076874
VL - 303
SP - R1127-35
JO - American Journal of Physiology
JF - American Journal of Physiology
SN - 0363-6119
IS - 11
ER -
ID: 236993674