Bedside Detection of Brain Ischemia Using Intracerebral Microdialysis: Subarachnoid Hemorrhage and Delayed Ischemic Deterioration

Bedside Detection of Brain Ischemia Using Intracerebral Microdialysis: Subarachnoid Hemorrhage... AbstractOBJECTIVE:Intracerebral microdialysis has been demonstrated to be a useful method for detection of brain ischemia in experimental models and in patients. We have applied new mobile microdialysate analysis equipment thal allows a bedside comparison of changes in neurochemistry with the neurological status of the patient. Ten patients with severe aneurysmal subarachnoid hemorrhage (that is, with a high risk of vasospasm and a high risk of subsequent ischemic deficits) were selectedMETHODS:Microdialysis catheters were inserted into the temporal and subfrontal cortex at the end of aneurysm surgery. Samples, collected hourly for 4 to 11 days, were analyzed immediately at the bedside for glucose, lactate, and glycerol and later for pyruvate and glutamate. The patients' neurological status was monitored constantly, and daily recordings of blood flow velocities were performed using transcranial Doppler sonographyRESULTS:Concentrations of the measured substances varied widely. Individual analyses revealed that patients with uneventful clinical courses generally demonstrated low and stable levels of the different metabolites, and those with signs of cerebral ischemia demonstrated various patterns of neurochemical changes. Lactate and glutamate seemed to be sensitive markers of impending ischemia, and increased glycerol levels were associated with severe ischemic deficits. Obtaining the microdialysis data directly at the bedside seemed to be of great advantage when relating the values to other clinical findingsCONCLUSION:Bedside intracerebral microdialysis monitoring of patients with subarachnoid hemorrhage and signs of delayed ischemia revealed dramatic changes in extracellular concentrations of glucose, lactate, and glycerol that could be directly correlated to the clinical status of the patients. These findings emphasize the potentials microdialysis in neurosurgical intensive care patients. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Bedside Detection of Brain Ischemia Using Intracerebral Microdialysis: Subarachnoid Hemorrhage and Delayed Ischemic Deterioration

Bedside Detection of Brain Ischemia Using Intracerebral Microdialysis: Subarachnoid Hemorrhage and Delayed Ischemic Deterioration

Bedside Detection of Brain Ischemia Using Intracerebral Microdialysis: Subarachnoid Hemorrhage and Delayed Ischemic Deterioration 3 Ola G. Nilsson, M.D., Lennart Brandt, M.D., Urban Ungerstedt, M.D., Hans Saveland, M.D. Department of Neurosurgery (OCN, LB, HS), University of Lund, Lund University Hospital, Lund, Sweden, and Departments of Physiology and Pharmacology (UU), Karolinska Institute, Stockholm, Sweden O B JE C T IV E : Intracerebral m icrodialysis has been demonstrated to be a useful method for detection of brain ischemia in experim ental models and in patients. W e have applied new m obile m icrodialysate analysis equipment thal allow s a bedside comparison of changes in neurochem istry w ith the neurological status of the patient. Ten patients w ith severe aneurysmal subarachnoid hem orrhage (that is, w ith a high risk of vasospasm and a high risk of subsequent ischem ic deficits) w ere selected. M E T H O D S : M icrodialysis catheters w ere inserted into the tem poral and subfrontal cortex at the end of aneurysm surgery. Samples, collected hourly for 4 to 11 days, w ere analyzed im m ediately at the bedside for glucose, lactate, and glycerol and later for pyruvate and glutamate. The patients' neurological status was m onitored constantly, and daily recordings of blood flow velocities w ere perform ed using transcranial D oppler sonography. RESU LTS: Concentrations of the measured substances varied w id ely. Individual analyses revealed that patients with uneventful clin ical courses generally demonstrated low and stable levels of the different metabolites, and those w ith signs of cerebral ischemia demonstrated various patterns of neurochem ical changes. Lactate and glutamate seemed to be sensitive markers of impending ischemia, and increased glycerol levels w ere associated with severe ischemic deficits. O btaining the m icrodialysis data d irectly at the bedside seemed to be of great advantage when relating the values to other clin ical...
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Publisher
Oxford University Press
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199911000-00032
Publisher site
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Abstract

AbstractOBJECTIVE:Intracerebral microdialysis has been demonstrated to be a useful method for detection of brain ischemia in experimental models and in patients. We have applied new mobile microdialysate analysis equipment thal allows a bedside comparison of changes in neurochemistry with the neurological status of the patient. Ten patients with severe aneurysmal subarachnoid hemorrhage (that is, with a high risk of vasospasm and a high risk of subsequent ischemic deficits) were selectedMETHODS:Microdialysis catheters were inserted into the temporal and subfrontal cortex at the end of aneurysm surgery. Samples, collected hourly for 4 to 11 days, were analyzed immediately at the bedside for glucose, lactate, and glycerol and later for pyruvate and glutamate. The patients' neurological status was monitored constantly, and daily recordings of blood flow velocities were performed using transcranial Doppler sonographyRESULTS:Concentrations of the measured substances varied widely. Individual analyses revealed that patients with uneventful clinical courses generally demonstrated low and stable levels of the different metabolites, and those with signs of cerebral ischemia demonstrated various patterns of neurochemical changes. Lactate and glutamate seemed to be sensitive markers of impending ischemia, and increased glycerol levels were associated with severe ischemic deficits. Obtaining the microdialysis data directly at the bedside seemed to be of great advantage when relating the values to other clinical findingsCONCLUSION:Bedside intracerebral microdialysis monitoring of patients with subarachnoid hemorrhage and signs of delayed ischemia revealed dramatic changes in extracellular concentrations of glucose, lactate, and glycerol that could be directly correlated to the clinical status of the patients. These findings emphasize the potentials microdialysis in neurosurgical intensive care patients.

Journal

NeurosurgeryOxford University Press

Published: Nov 1, 1999

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