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2014, Number 3

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Med Crit 2014; 28 (3)

Cerebrovascular reactivity in sepsis and septic shock at high altitude

Viruez-Soto JA, Da Re-Gutiérrez S, Ibáñez-Guzmán C
Full text How to cite this article

Language: Spanish
References: 8
Page: 154-158
PDF size: 195.29 Kb.


Key words:

Cerebral vasoreactivity, sepsis, high altitude.

ABSTRACT

Objective: To evaluate a significant compromise in cerebrovascular reactivity in septic and septic shock patients at 3,600 meter above the sea level.
Design: Prospective longitudinal case-control study.
Field: Intensive care unit of the «Hospital Obrero Número 1 de la Caja Nacional de Salud», a tertiary university hospital, in La Paz, Bolivia during the period November 2011–February 2012.
Patients and participants: Septic patients (n = 10) and «healthy» volunteers (n = 11), all residents of 3,600 meter above the sea level during the last six months.
Results: With transcranial ecodoppler, the mean velocity of the cerebral blood flow of the middle cerebral artery with the best insonation sign was measured, before and after the administration of 1 g of acetazolamide. The velocity in the «septic group» increased 31.9% and in the «control group» 30.2% (p = 0.3770, CI 95% from 0.1559 to 0.597), without significant changes in the pulsatility index nor the mean arterial pressure.
Conclusion: This study demonstrates the lack of significant compromise of cerebrovascular reactivity in septic patients at high altitude.


REFERENCES

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  2. Zirak P, Delgado-Mederos R, Mart J, Marti-Fabregas J, Durduran T. Effects of acetazolamide on the micro and macro-vascular cerebral hemodynamics: a diffuse optical and transcranial doppler ultrasound study. Optical Society of America. 2010;l(5):1443-1459.

  3. Settakis G, Molnár C, Kerényi L, Kollár J, Legemate D, Csiba L, Fülesdi B. Acetazolamide as a vasodilatory stimulus in cerebrovascular diseases and in conditions affecting the cerebral vasculature. European Journal of Neurology. 2003;10:609-620.

  4. Delgado C, Portolés J. Fármacos diuréticos. En: Lorenzo P, Moreno A, Lizasoain I, Leza JC, Moro MA, Portolés J. Velázquez. Farmacología básica y clínica. Madrid: Editorial Médica Panamericana; 2008: p. 408-409.

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  6. Jackson E. Diuréticos. En: Hardman J, Limbird L. Goodman & Gilman. Las bases farmacológicas de la terapéutica. México D.F.: McGraw-Hill Interamericana; 2001. p. 777-778.

  7. Piepgras A, Schmiedek P, Leinsinger G, Haberl RL, Kirsch CM, Einhaupl KM. A simple test to assess cerebrovascular reserve capacity using transcranial Doppler sonography and acetazolamide. Stroke. 1990;21:1306-1311.

  8. Steiner LA, Pfister D, Strebel SP, Radolovich D, Smielewski P, Czosnyka M. Near-Infrared Spectroscopy can Monitor Dynamic Cerebral Autoregulation in Adults. Neurocrit Care. 2009;10:122-128.




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Med Crit. 2014;28