Intracerebral microdialysis and bedside biochemical analysis in patients with fatal traumatic brain lesions

• Published in: Acta anaesthesiologica Scandinavica Vol. 45; no. 8; pp. 977 - 985
• Main Authors: Ståhl, N., Mellergård, P., Hallström, A., Ungerstedt, U., Nordström, C. H.
• Format: Journal Article
• Language: English
• Published: Copenhagen Munksgaard International Publishers 01-09-2001; Blackwell
• Subjects: Adult; Aged; Biological and medical sciences; Brain - metabolism; Brain Injuries - metabolism; Brain Ischemia - metabolism; cerebral ischemia; Energy Metabolism; Female; glucose; Glucose - metabolism; glutamate; glycerol; Glycerol - metabolism; Head injury; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Intracranial Pressure; Investigative techniques, diagnostic techniques (general aspects); lactate; Lactic Acid - metabolism; Male; Medical sciences; Medicin och hälsovetenskap; Microdialysis; Middle Aged; Nervous system; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; pyruvate; Pyruvic Acid - metabolism; Traumas. Diseases due to physical agents; Human; Nervous system diseases; Energy metabolism; Craniocerebral; Intracranial hypertension; Diseases of the osteoarticular system; Central nervous system; Pyruvate; Cardiovascular disease; Exploration; Glucose; Glutamate; Trauma; Cerebral disorder; Vascular disease; Lactates; Microdialysis; Ischemia; Central nervous system disease; Skull disease; Cerebrovascular disease; Brain (vertebrata)
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1034/j.1399-6576.2001.450810.x

Background: Microdialysis with bedside biochemical analysis was used to monitor cerebral biochemical alterations that precede and accompany increase in intracranial pressure (ICP), resulting in a complete cessation of cerebral blood flow.
Methods: Seven patients, who died due to an untreatable increase in ICP, were included. The patients originate from a large, consecutive series of severely head injured patients (n: 95) monitored with intracerebral microdialysis (perfusion rate 0.3 μl/min). One microdialysis catheter was inserted via a separate burr hole frontally to that used for the intraventricular catheter (”better” position) and one catheter was inserted into cerebral cortex surrounding an evacuated focal contusion or underlying an evacuated haematoma (”worse” position). Biochemical analyses of glucose, lactate, glycerol, urea, glutamate, and pyruvate were performed at the bedside. All samples were frozen for subsequent HPLC (high‐performance liquid chromatography) analyses of amino acids and ions.
Results: Decreases in glucose and pyruvate and increases in lactate, glycerol, glutamate, and lactate/pyruvate (la/py) ratio characterized cerebral ischaemia. The measured markers give information regarding substrate availability (glucose), redox state of the tissue (la/py ratio), degradation of glycerophospholipids in cell membranes (glycerol), and extracellular concentration of excitatory amino acids (glutamate). In the “worse” position biochemical deterioration occurred before the increase in ICP. In the “better” position biochemical deterioration was usually observed after the increase in ICP.
Conclusion: Changes of cerebral energy metabolism that accompany cerebral ischaemia follow a certain pattern and may be detected at the bedside by intracerebral microdialysis before the secondary damage causes an increase in ICP.