Encephalopathies

Enchephalopathies are pathological states that affect the brain function. In the surgical intensive care setting, there are several etiologies that must be considered when a change in neurologic function occurs. The neurologic change can be mild, with confusion, agitation, personality change, memory loss or somnolence. It can also be severe, with hallucinations, seizures and coma.

The causes of encephalopathy run the gamut of risks intrinsic to surgical ICU patients:

Post Anesthesia
Drug related (including: recreational, pre-hospital and current treatment meds)
Uremic
Hepatic
Hypertensive
Hypoxic
Metabolic: acidosis / mineral, electrolyte, vitamin deficiencies
Sepsis related
Primary Brain infection (viral and bacterial)
Wernicke (B1 deficiency commonly seen in alcohol use disorder)

The two over-arching goals for treating encephalopathy in the surgical ICU patient are:

Supportive care with goals of: adequate oxygenation, adequate perfusion and treatment of elevated ICPs (if needed).
If an underlying cause can be determined, targeted therapy to eliminate cause of brain dysfunction.
Since encephalopathy is multifactorial, other causes for neurologic dysfunction can slow recovery, even if a presumed primary source is being addressed. (e.g. dialysis for uremia). For this reason, ICU care of severe encephalopathies must include: nutrition, maintenance of electrolyte levels, respiratory support / hygiene and frequent neuro-monitoring.