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Metabolic failure precedes intracranial pressure rises in traumatic brain injury: a microdialysis study

Metabolic failure precedes intracranial pressure rises in traumatic brain injury: a microdialysis study
Metabolic failure precedes intracranial pressure rises in traumatic brain injury: a microdialysis study
Background: Cerebral microdialysis (MD) is able to detect markers of tissue damage and cerebral ischaemia and can be used to monitor the biochemical changes subsequent to head injury. In this prospective, observational study we analysed the correlation between microdialysis markers of metabolic impairment and intracranial pressure (ICP) and investigated whether changes in biomarker concentration precede rises in ICP.
Methods: MD and ICP monitoring was carried out in twenty-five patients with severe TBI in Neurointensive care. MD samples were analysed hourly for lactate:pyruvate (LP) ratio, glutamate and glycerol. Abnormal values of microdialysis variables in presence of normal ICP were used to calculate the risk of intracranial hypertension developing within the next 3h.
Findings: An LP ratio > 25 and glycerol > 100 mu mol/L, but not glutamate > 12 mu mol/L, were associated with significantly higher risk of imminent intracranial hypertension (odds ratio: 9.8, CI 5.8-16.1; 2.2, CI 1.6-3.8; 1.7, CI 0.6-3, respectively). An abnormal LP ratio could predict an ICP rise above normal levels in 89% of cases, whereas glycerol and glutamate had a poorer predictive value.
Conclusions: Changes in the compound concentrations in microdialysate are a useful tool to describe molecular events triggered by TBI. These changes can occur before the onset of intracranial hypertension, suggesting that biochemical impairment can be present before low cerebral perfusion pressure is detectable. This early warning could be exploited to expand the window for therapeutic intervention
mitochondrial dysfunction, risk, positron-emission-tomography, intracerebral microdialysis, failure, substrate delivery, lactate, microdialysis, severe head-injury, aneurysmal subarachnoid hemorrhage, icp, care, energy-metabolism, traumatic brain injury, glutamate, glycerol, pyruvate ratio, n-acetylaspartate, cerebral metabolism, membrane phospholipid degradation
0001-6268
461-470
Belli, A.
173116e3-a9e8-4ed2-afc4-932f7001eeb0
Sen, J.
afcde186-d116-4538-bd4e-6d8ba01746b3
Petzold, A.
3142ddf4-b2e1-4f9f-bfad-ba869e3b190f
Russo, S.
264ab2ce-7e79-4f81-81ea-144a7f4623db
Kitchen, N.
28d7232f-fd11-4ae3-9eb6-05845dcf9200
Smith, M.
558e1c6b-5c57-444a-9508-509c50128f91
Belli, A.
173116e3-a9e8-4ed2-afc4-932f7001eeb0
Sen, J.
afcde186-d116-4538-bd4e-6d8ba01746b3
Petzold, A.
3142ddf4-b2e1-4f9f-bfad-ba869e3b190f
Russo, S.
264ab2ce-7e79-4f81-81ea-144a7f4623db
Kitchen, N.
28d7232f-fd11-4ae3-9eb6-05845dcf9200
Smith, M.
558e1c6b-5c57-444a-9508-509c50128f91

Belli, A., Sen, J., Petzold, A., Russo, S., Kitchen, N. and Smith, M. (2008) Metabolic failure precedes intracranial pressure rises in traumatic brain injury: a microdialysis study. Acta Neurochirurgica, 150 (5), 461-470. (doi:10.1007/s00701-008-1580-3).

Record type: Article

Abstract

Background: Cerebral microdialysis (MD) is able to detect markers of tissue damage and cerebral ischaemia and can be used to monitor the biochemical changes subsequent to head injury. In this prospective, observational study we analysed the correlation between microdialysis markers of metabolic impairment and intracranial pressure (ICP) and investigated whether changes in biomarker concentration precede rises in ICP.
Methods: MD and ICP monitoring was carried out in twenty-five patients with severe TBI in Neurointensive care. MD samples were analysed hourly for lactate:pyruvate (LP) ratio, glutamate and glycerol. Abnormal values of microdialysis variables in presence of normal ICP were used to calculate the risk of intracranial hypertension developing within the next 3h.
Findings: An LP ratio > 25 and glycerol > 100 mu mol/L, but not glutamate > 12 mu mol/L, were associated with significantly higher risk of imminent intracranial hypertension (odds ratio: 9.8, CI 5.8-16.1; 2.2, CI 1.6-3.8; 1.7, CI 0.6-3, respectively). An abnormal LP ratio could predict an ICP rise above normal levels in 89% of cases, whereas glycerol and glutamate had a poorer predictive value.
Conclusions: Changes in the compound concentrations in microdialysate are a useful tool to describe molecular events triggered by TBI. These changes can occur before the onset of intracranial hypertension, suggesting that biochemical impairment can be present before low cerebral perfusion pressure is detectable. This early warning could be exploited to expand the window for therapeutic intervention

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More information

Published date: 2008
Keywords: mitochondrial dysfunction, risk, positron-emission-tomography, intracerebral microdialysis, failure, substrate delivery, lactate, microdialysis, severe head-injury, aneurysmal subarachnoid hemorrhage, icp, care, energy-metabolism, traumatic brain injury, glutamate, glycerol, pyruvate ratio, n-acetylaspartate, cerebral metabolism, membrane phospholipid degradation

Identifiers

Local EPrints ID: 62320
URI: https://eprints.soton.ac.uk/id/eprint/62320
ISSN: 0001-6268
PURE UUID: 6741e4fa-110b-440f-81f9-359d4a3e121f

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Date deposited: 02 Sep 2008
Last modified: 13 Mar 2019 20:27

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Contributors

Author: A. Belli
Author: J. Sen
Author: A. Petzold
Author: S. Russo
Author: N. Kitchen
Author: M. Smith

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