title: Is impaired cerebrovascular autoregulation associated with outcome in patients admitted to the ICU with early septic shock?
abstract: OBJECTIVE
  To investigate the correlation between early changes in cerebrovascular autoregulation (CVAR) and neurological outcome and mortality in patients admitted to the intensive care unit with septic shock.
  
  
  METHODS
  A prospective observational study in a tertiary, university-affiliated ICU, of 28 patients with septic shock (median age, 66 years; interquartile range [IQR], 56-74 years), with a median APACHE III score of 86 (IQR, 55-119).
  
  
  METHODS
  We used the correlation in time between cerebral tissue oxygenation (measured with near infrared spectroscopy) and mean arterial pressure to determine the tissue oxygenation reactivity index (TOx) as a measure of CVAR. Low TOx represents intact CVAR and high TOx represents impaired CVAR. We performed the measurements in the first 3 days after admission to the ICU. Survival and neurological outcomes, measured using the modified Rankin Scale and the Cerebral Performance Category scale, were censored 3 months later.
  
  
  RESULTS
  All survivors of septic shock had a good neurological outcome. The TOx for Days 1-3 was higher (P < 0.001) in non-survivors (median, 0.04 [IQR, 0.12- 0.24]) compared with survivors (median, -0.02 [IQR, -0.13 to 0.05]). The TOx was independently associated with survival at 3 months (odds ratio, 0.13 [95% CI, 0.01-0.69]; P < 0.05) using logistic regression analysis.
  
  
  CONCLUSIONS
  CVAR is impaired early in septic shock and is independently associated with mortality at 3-month follow-up. Information based on bedside monitoring of CVAR in the ICU could form a valuable adjunct to guide haemodynamic optimisation in patients with septic shock.
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia. anders.aneman@swsahs.nsw.gov.au.
authors.forename: Jessica
authors.initials: J
authors.lastname: Bindra
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Pham
authors.affiliation: Department of Anaesthesia, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia.
authors.forename: Alwin
authors.initials: A
authors.lastname: Chuan
authors.affiliation: Department of Neurosurgery, Wollongong Hospital, Wollongong, NSW, Australia.
authors.forename: Matthias
authors.initials: M
authors.lastname: Jaeger
authors.affiliation: Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia.
authors.forename: Anders
authors.initials: A
authors.lastname: Aneman
mesh_terms: D000368:Aged; D062186:Arterial Pressure / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D012772:Shock, Septic / Q000453:epidemiology* / Q000503:physiopathology*; D019265:Spectroscopy, Near-Infrared