Cerebral Pulsatility Index Compared To Mean Arterial Blood Pressure Guided Protocol In Sepsis Induced Encephalopathy:
- Conditions
- SepsisEncephalopathyNorepinephrine
- Interventions
- Other: Transcranial doppler pulsatility index guided protocolOther: Mean arterial blood pressure guided protocol
- Registration Number
- NCT05842616
- Lead Sponsor
- Tanta University
- 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.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 112
- Patients aged 18 years or older
- Must had clinical diagnosis of sepsis induced encephalopathy.
- 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).
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Transcranial doppler pulsatility index guided protocol Transcranial doppler pulsatility index guided protocol Norepinephrine titration that will be guided by Transcranial doppler (TCD) pulsatility index. Mean arterial blood pressure guided protocol Mean arterial blood pressure guided protocol Norepinephrine titration that will be guided by Mean arterial blood pressure (MAP).
- Primary Outcome Measures
Name Time Method Intensive care unit (ICU) mortality 28 day or till death which earlier Incidence of Intensive care unit (ICU) stay will be recorded
- Secondary Outcome Measures
Name Time Method Outcome of encephalopathy 28 day Encephalopathy outcome at ICU discharge using Glasgow coma scale (GCS)
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).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).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
Trial Locations
- Locations (1)
Tanta University Hospitals
🇪🇬Tanta, Elgharbia, Egypt