Encephalopathy, Norepinephrine, Sepsis
Conditions
Brief summary
The aim of our study is to compare between transcranial doppler pulsatility index and mean arterial blood pressure in guiding management of sepsis induced encephalopathy.
Detailed description
Sepsis induced encephalopathy is the most frequent sepsis related organ dysfunction. It appears early during the course of infection, often before any other organ involvement in up to 70% of hospitalized septic patients and is associated with significant change of cerebral circulation caused by redistribution of blood flow during sepsis that accompanies the abnormal inflammatory response during an infection, in absence of direct central nervous system involvement.
Interventions
OTHERTranscranial doppler pulsatility index guided protocol
Norepinephrine titration that will be guided by Transcranial doppler pulsatility index.
OTHERMean arterial blood pressure guided protocol
Norepinephrine titration that will be guided by Mean arterial blood pressure (MAP).
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients aged 18 years or older * Must had clinical diagnosis of sepsis induced encephalopathy.
Exclusion criteria
* Refusal to participate in the study. * Cerebral infection. * Known cerebral lesions (Neoplasm, Traumatic brain injury, Stroke, Ischemic or hemorrhagic cerebrovascular lesions, high intracranial pressure). * Known severe carotid stenosis (\>70％). * Intoxication due to drugs. * Pregnancy. * Patients supported by intra-aortic balloon pumb (IABP).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Intensive care unit (ICU) mortality | 28 day or till death which earlier | Incidence of Intensive care unit (ICU) stay will be recorded |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Outcome of encephalopathy | 28 day | Encephalopathy outcome at ICU discharge using Glasgow coma scale (GCS) |
| SOFA score | Up to 4 weeks. | SOFA score at ICU admission and discharge. |
| Length of ICU stay | At least 28 days | Length of ICU stay |
| Norepinephrine titration | 24 hours | Fluid resuscitation will be started using crystalloids at a rate of 4 to 6 ml/kg with reevaluation after 15 minutes. If MAP is still less than 65 mmhg, fluid resuscitation should be continued at a rate of 4 to 6 ml/kg with reevaluation after another 15 minutes up to 30 ml/kg. Vasopressors will be started if the patient is still hypotensive during or after resuscitation without delay even peripherally to avoid delay until central venous access is secured (norepinephrine is the first line agent preferred over other vasopressors). |
| Cerebral perfusion pressure | 24 hours | Cerebral perfusion pressure (CPP) will be done using transcranial doppler. |
| Mean arterial pressure | 24 hours | Fluid resuscitation will be started using crystalloids at a rate of 4 to 6 ml/kg with reevaluation after 15 minutes. If MAP is still less than 65 mmhg, fluid resuscitation should be continued at a rate of 4 to 6 ml/kg with reevaluation after another 15 minutes up to 30 ml/kg. Vasopressors will be started if the patient is still hypotensive during or after resuscitation without delay even peripherally to avoid delay until central venous access is secured (norepinephrine is the first line agent preferred over other vasopressors). |
Countries
Egypt
Outcome results
None listed