The following is a summary of “ In-Hospital neurologic complications, neuromonitoring, and long-term neurologic outcomes in patients With sepsis: A systematic review and meta-analysis,” published in March 2024, issue of Critical Care by Fan et al.
Extensive data exists for delirium in septic patients, yet comprehensive data regarding other neurological complications remain limited.
Researchers conducted a retrospective study exploring the occurrence rates, types of neuromonitoring utilized, and the neurocognitive consequences in septic patients who manifest neurological complications.
They conducted a systematic review and studied databases of MEDLINE, Embase, Web of Science, Cochrane CENTRAL and ClinicalTrials.gov (January 2023). Which included studies on adult sepsis patients reporting neurological complications, neuromonitoring tool usage, neuropathology, and cognitive outcomes. Data were independently extracted by two reviewers and meta-analyzed using random-effect methods for pooling.
The results showed 74 studies, with a total of 146,855 participants. Neurologic complications were documented in 38 studies encompassing 142,193 participants. Complications included septic encephalopathy (36%, 95% CI, 27–46%; I 2 = 99%), ischemic stroke (5%, 95% CI, 2.1–11.5; I 2 = 99%), intracranial hemorrhage (2%, 95% CI, 1.0–4.4%; I2 = 96%), seizures (1%, 95% CI, 0.2–7%; I 2 = 96%), posterior reversible encephalopathy syndrome (9%), and hypoxic-ischemic brain injury (7%). Factors like pulmonary infection, gram-positive sepsis, higher organ failure and admission scores, and longer ICU stays increased the risk of septic encephalopathy.Three studies of 159 participants found 47% had acute brain injury. Among 26 studies (n = 1,358) on neuromonitoring, EEG was primary for seizures. Transcranial Doppler and near infrared spectroscopy detected early ischemia. Six studies (n = 415) reported cognitive outcomes up to 12 months post-discharge, noting 30% cognitive impairment.
Investigators concluded that neurologic complications during sepsis were frequent, but their timing and mechanism remain unclear. Limited data exist on standardized neuromonitoring for this group.
Source: journals.lww.com/ccmjournal/fulltext/2024/03000/in_hospital_neurologic_complications,.10.aspx