Cerebral circulation and metabolism associated with other organ failure in septic patients

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In central nervous system(CNS)dysfunction observed in septic patients,septic encephalopathy,the authors have examined cerebral circulation and metabolism,and their relation to pathophysiologic derangement of hepatic/renal function and amino acid metabolism.Furthermore,they have measured phagocytic activity of neutrophiles in blood samples obtained from septic pateints.The results and their implications are as follows; 1.Cerebral circulation/metabolism and organ failure in septic encephalopathy Nineteen patients with septic encephalopathy were divided into two groups according to Hockaday's classification of electroencephalogram(EEG).In pateints whose EEG was classified as grade III-IV,the latency of wave V in auditory evoked response(ABR)was significantly lengthened than that in patients whose EEG was classified as grade I-II. Thus, both cerebral and brain stem electric activities are similarly affected by septic encephalopathy.Results in the measurement of cerebral blood flow,metaboli … More c rate for oxygen,and flow velocity of the middle cerebral artery using transcranial Doppler sonography indicated the impaired circulation and the decreased metabolic activity of the septic brain.In those patients,severe abnormalities in hepatic function(prothrombine time;PT),renal function(serum creatinine level;S-Cre),hemostasis(Platelet count;PLT),and amino acid metabolism(Fisher's ratio;FR)were observed.When those results were statistically analyzed with EEG findings using the stepwise multiple regression,the combination of factors most significantly correlated to EEG abnormality was revealed FR and S-Cre.This may imply that septic encephalopathy is a CNS manifestation of septic multiple organ failure.Of four patients who received bifemelane HCI in order to improve sustained impairment of consciousness level,two patients partially regained consciousness.Clinical study upon the beneficial effect of bifemerane HCI is warranted.2.Phagocytotic activity of neutrophiles in septic patients Luminol-dependent chemiluminescence(CL)was measured in the whole blood sample.Between healthy volunteers (n=10)and septic patients(n=11)in the acute ICU setting,white blood cell count(WBC),neutrophile count(Large cell fraction measured using Toa Iryo Densi Co.SYSMEX;LCC),peak chemiluminescence activity(pCL),time to peak CL (TP),and pCL/LCC were compared.As a result,in septic patients,averaged phagocytic activity for 10^6 neutrophiles represented by pCL/LCC was significantly enhanced,compared to that in healthy volunteers,in addition to an increase in WBC&LCC.Further study is necessary to clarify the relation between neutrophile CL,EEG,and organ function. Less