Transcranial doppler as an early predictor of Delerium in septic patients and its correlation with Jagular Venous Oxygen saturation

ABSTRACT

Background: Impairment of cerebrovascular autoregulation is considered one of the most important mechanisms leading to cerebral hypo- or hyperperfusion in haemodynamically unstable septic patients. That may lead to Sepsis-associated delirium (SAD) which increases morbidity and mortality.  Objective: To investigate the ability of Trans cranial Doppler (TCD) for prediction of delirium in septic patient and its relationship with jagular venous oxygen saturation (JVo2) levels.

Method: On the first day we used a 3-MHz Tran’s cranial Doppler   probe to measure the Blood velocity and Pulsatility index in the middle cerebral artery (VMCA) TCD was then repeated daily for 3 consecutive days. Simultaneously we measured r jugular venous oxygen saturation (JVO2) on the same side of the highest VMCA.  Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) was done for each patient once per day throughout ICU stay and after 6 hours after stoppage of sedation in sedated patient.

Results: Out of 159 patients, 91 developed delirium. APACHE score was higher in the delirium group. Patients who developed delirium had significantly longer ICU LOS 13.9 day’s vs 7.8 Delirium group had lower mean MCA velocity  and higher pulsatility index at all times .Positive correlation was observed between Jvo2 and VMCA on day 2 (r=0.8), and on day 3 (r=0.69). There was a negative correlation between PI and JVo2 on day 2(r= -0.5) and day 3(r=-o.57). Roc curve analyses the ability to detect delirium with a cut off value for Jvo2 measured at day 3(Jvo2 3) of 53.5 % (sensitivity 100%, specificity 100%, P <0.05), and a cut off value for the PI at day 3 (PI3) of 1.2. (AUC= 0.88, CI 95%, 0.83-0.9 P <0.05vsensitivity 70%, specificity 100%).

Conclusion: Changes in TCD findings together with JVo2 levels are associated with the development of delirium in septic patients.

Key words:  Transcranial Doppler, Sepsis, Delirium, Sepsis, Jugular venous oxygen saturation.

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