Diagnostics of Central and Autonomic Nervous System Dysfunction in Patients with Sepsis-Associated Encephalopathy

Abstract

This chapter is devoted to monitoring of central and autonomic nervous system (ANS) in patients with verified sepsis to recognize the specific functional and anatomic changes in the brain and its important autonomic centers which is named sepsis-associated encephalopathy (SAE). Fluctuation of conscience level from agitation to delirium and coma, muscle tone, and severity of pain syndrome is evaluated with different scales (SOFA, SAPS II, RASS, CAM-ICU, FOUR, PBSS, BPS, MRC, MAS, CNS). Multimodal neuromonitoring includes EEG, EPs, ENMG, cerebral oxymetry, saturation in the bulb of the jugular vein, TCD, and neuroimaging (MRI, PET). Dysfunction of autonomic brainstem structures is detected with variational cardiointervalometry, pupillometry, thermometry (peripheral and central), photoplethysmography assessment of perfusion index, quantitative assessment of muscle strength on the MRC scale and MAS, and diagnostics of the severity of the PSH syndrome. Monitoring data help clinicians to make decisions on SAE patient management tactics.