Replacement Selenium Therapy in Acute Cerebral Damage

The current literature covers the role of selenium in metabolic processes and the importance of correcting its level in various diseases and critical conditions, including acute cerebral damage due to severe traumatic brain injury (TBI) and sepsis-associated encephalopathy (SAE). Numerous experimental animal studies have demonstrated that selenium has protective properties and blocks the mechanisms of apoptosis, and is involved in maintaining the functional activity of neurons and inhibits astrogliosis. The study of the selenium content in the blood of patients with acute cerebral damage due to severe TBI and sepsis with verified SAE, and the development of schemes of replacement selenium therapy will improve outcomes, both in increasing survival and in reducing the resuscitation bed-day and the number of neurological deficits in the future

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

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