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Cerebral Microbleeds in Critically Ill Patients with Respiratory Failure or Sepsis: A Scoping Review
Bing Yu Chen1, Johnny Dang2, Sung-Min Cho3
1Cerebrovascular Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA. chenb5@ccf.org.
Background:
Cerebral microbleeds (CMBs) have been described in critically ill patients with respiratory failure, acute respiratory distress syndrome (ARDS), or sepsis. This scoping review aimed to systematically summarize existing literature on critical illness-associated CMBs.
Methods:
Studies reporting on adults admitted to the intensive care unit for respiratory failure, ARDS, or sepsis with evidence of CMBs on magnetic resonance imaging were included for review following a systematic search across five databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science) and a two-stage screening process. Studies were excluded if patients' CMBs were clearly explained by another process of neurological injury.
Results:
Forty-eight studies reporting on 216 critically ill patients (mean age 57.9, 18.4% female) with CMBs were included. Of 216, 197 (91.2%) patients developed respiratory failure or ARDS, five (2.3%) patients developed sepsis, and 14 (6.5%) patients developed both respiratory failure and sepsis. Of 211 patients with respiratory failure, 160 (75.8%) patients had coronavirus disease 2019. The prevalence of CMBs among critically ill patients with respiratory failure or ARDS was 30.0% (111 of 370 patients in cohort studies). The corpus callosum and juxtacortical area were the most frequently involved sites for CMBs (64.8% and 41.7% of all 216 patients, respectively). Functional outcomes were only reported in 48 patients, among whom 31 (64.6%) were independent at discharge, four (8.3%) were dependent at discharge, and 13 (27.1%) did not survive until discharge. Cognitive outcomes were only reported in 11 of 216 patients (5.1%), all of whom showed cognitive deficits (nine patients with executive dysfunction and two patients with memory deficits).
Conclusions:
Cerebral microbleeds are commonly reported in patients with critical illness due to respiratory failure, ARDS, or sepsis. CMBs had a predilection for the corpus callosum and juxtacortical area, which may be specific to critical illness-associated CMBs. Functional and cognitive outcomes of these lesions are largely unknown.
Insights
Cerebral microbleeds (CMBs) are common in critically ill patients with ARDS or sepsis. These brain lesions often affect the corpus callosum and juxtacortical areas, but their long-term impact remains unclear.
Area of Science:
- Neurology
- Critical Care Medicine
- Radiology
Background:
- Cerebral microbleeds (CMBs) are observed in critically ill patients experiencing respiratory failure, acute respiratory distress syndrome (ARDS), or sepsis.
- Existing literature on critical illness-associated CMBs requires systematic summarization.
Purpose of the Study:
- To systematically review and summarize the current literature on cerebral microbleeds in critically ill patients with respiratory failure, ARDS, or sepsis.
Main Methods:
- A systematic search was conducted across five major databases (MEDLINE, Embase, CENTRAL, Scopus, Web of Science).
- Studies included adult intensive care unit patients with respiratory failure, ARDS, or sepsis and evidence of CMBs on MRI.
- Studies were excluded if CMBs had a clear alternative explanation for neurological injury.
Main Results:
- The review included 48 studies involving 216 critically ill patients with CMBs.
- Respiratory failure or ARDS was the primary condition in 91.2% of patients; sepsis was present in 2.3%, and both in 6.5%.
- CMBs prevalence was 30% in patients with respiratory failure or ARDS, frequently impacting the corpus callosum (64.8%) and juxtacortical areas (41.7%).
Conclusions:
- Cerebral microbleeds are frequently identified in critically ill patients with respiratory failure, ARDS, or sepsis.
- The predilection for corpus callosum and juxtacortical areas may be characteristic of critical illness-associated CMBs.
- Functional and cognitive outcomes associated with these microbleeds are largely undetermined.
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