Cerebral autoregulation-directed optimal blood pressure management reduced the risk of delirium in patients with septic shock

Qianyi Peng; Xia Liu; Meilin Ai; Li Huang; Li Li; Wei Liu; Chunguang Zhao; Chenghuan Hu; Lina Zhang

Journal of Intensive Medicine (Jul 2024)

Cerebral autoregulation-directed optimal blood pressure management reduced the risk of delirium in patients with septic shock

Qianyi Peng,
Xia Liu,
Meilin Ai,
Li Huang,
Li Li,
Wei Liu,
Chunguang Zhao,
Chenghuan Hu,
Lina Zhang

Affiliations

Qianyi Peng: Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
Xia Liu: Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
Meilin Ai: Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
Li Huang: Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
Li Li: Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
Wei Liu: Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
Chunguang Zhao: Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
Chenghuan Hu: Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
Lina Zhang: Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Corresponding author: Lina Zhang, Department of Critical Care Medicine, Xiangya Hospital, No. 87 Xiangya Road, Changsha, Hunan 410008, China.

Journal volume & issue: Vol. 4, no. 3
pp. 376 – 383

Abstract

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Background: When resuscitating patients with septic shock, cerebrovascular reactivity parameters are calculated by monitoring regional cerebral oxygen saturation (rSO2) using near-infrared spectroscopy to determine the optimal blood pressure. Here, we aimed to analyze the impact of cerebral autoregulation-directed optimal blood pressure management on the incidence of delirium and the prognosis of patients with septic shock. Methods: This prospective randomized controlled clinical study was conducted in the Xiangya Hospital of Central South University, China. Fifty-one patients with septic shock (December 2020–May 2022) were enrolled and randomly allocated to the experimental (n=26) or control group (n=25). Using the ICM+ software, we monitored the dynamic changes in rSO2 and mean arterial pressure (MAP) and calculated the cerebrovascular reactivity parameter tissue oxygen reactivity index to determine the optimal blood pressure to maintain normal cerebral autoregulation function during resuscitation in the experimental group. The control group was treated according to the Surviving Sepsis Campaign Guidelines. Differences in the incidence of delirium and 28-day mortality between the two groups were compared, and the risk factors were analyzed. Results: The 51 patients, including 39 male and 12 female, had a mean age of (57.0±14.9) years. The incidence of delirium was 40.1% (23/51), and the 28-day mortality rate was 29.4% (15/51). The mean MAP during the first 24 h of intensive care unit (ICU) admission was higher ([84.5±12.2] mmHg vs. [77.4±11.8] mmHg, P=0.040), and the incidence of delirium was lower (30.8% vs. 60.0%, P=0.036) in the experimental group than in the control group. The use of cerebral autoregulation-directed optimal blood pressure (odds ratio [OR]=0.090, 95% confidence interval [CI]: 0.009 to 0.923, P=0.043) and length of ICU stay (OR=1.473, 95% CI: 1.093 to 1.985, P=0.011) were risk factors for delirium during septic shock. Vasoactive drug dose (OR=8.445, 95% CI: 1.26 to 56.576, P=0.028) and partial pressure of oxygen (PaO2) (OR=0.958, 95% CI: 0.921 to 0.996, P=0.032) were the risk factors for 28-day mortality. Conclusions: The use of cerebral autoregulation-directed optimal blood pressure management during shock resuscitation reduces the incidence of delirium in patients with septic shock. Trial Registration: ClinicalTrials.gov ldentifer: NCT03879317

Published in Journal of Intensive Medicine

ISSN: 2667-100X (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.journals.elsevier.com/journal-of-intensive-medicine

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