Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage

Patet, Camille; Quintard, Hervé; Zerlauth, Jean-Baptiste; Maibach, Thomas; Carteron, Laurent; Suys, Tamarah; Bouzat, Pierre; Bervini, David; Levivier, Marc; Daniel, Roy Thomas; Eckert, Philippe; Meuli, Reto; Oddo, Mauro

doi:10.1136/jnnp-2016-313766

Cited by 29 publications

(34 citation statements)

References 26 publications

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“…Several studies investigated metabolic changes associated with parameters of cerebral perfusion, including CBF, CPP, and imaging surrogates. In summary, a negative correlation between CBF and CMD-lactate, CMD-LPR, CMD-glutamate, and CMD-glycerol has been described, while CMD-pyruvate and CMD-glucose are commonly positively correlated with CBF ( 25 , 31 , 32 , 35 , 38 – 40 ). Other studies focused on DCI and found increases in CMD-lactate and CMD-glutamate as early sensitive markers ( 17 ).…”

Section: Resultsmentioning

confidence: 90%

“…Other studies focused on DCI and found increases in CMD-lactate and CMD-glutamate as early sensitive markers ( 17 ). Metabolic derangement with increasing CMD-LPR (> 40) and decreasing CMD-glucose (< 0.7 mmol/l) may occur up to 16 h before DCI onset ( 26 , 32 ). In the following, we give detailed information on some studies, all studies are listed in Table 4 .…”

Section: Resultsmentioning

confidence: 99%

“…Changes in CMD parameters were observed even 12–16 h before the occurrence of DCI and included a significant increase in CMD-LPR to values >40 and decreases in CMD-glucose to levels <0.7 mmol/l ( 26 , 32 , 37 ). At a comparable time point, also elevations of CMD-lactate, CMD-glutamate, and CMD-glycerol were reported ( 43 , 44 ).…”

Section: Resultsmentioning

confidence: 99%

“…However, CMD parameters showed a higher specificity for predicting DCI than transcranial ultrasound and conventional angiography ( 37 , 43 , 44 ). Regarding trend analyses, a CMD-LPR increase above 40 and decreasing CMD-glucose concentrations preceded the occurrence of delayed ischemia by several hours ( 26 , 32 ); however, ischemia that occurred remote from the CMD probe or in the contralateral hemisphere was not detected ( 26 ).…”

Section: Resultsmentioning

confidence: 99%

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Clinical Use of Cerebral Microdialysis in Patients with Aneurysmal Subarachnoid Hemorrhage—State of the Art

et al. 2017

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ObjectiveTo review the published literature on the clinical application of cerebral microdialysis (CMD) in aneurysmal subarachnoid hemorrhage (SAH) patients and to summarize the evidence relating cerebral metabolism to pathophysiology, secondary brain injury, and outcome.MethodsStudy selection: Two reviewers identified all manuscripts reporting on the clinical use of CMD in aneurysmal SAH patients from MEDLINE. All identified studies were grouped according to their focus on brain metabolic changes during the early and subacute phase after SAH, their association with mechanisms of secondary brain injury and outcome.ResultsThe review demonstrated: (1) limited literature is available in the very early phase before the aneurysm is secured. (2) Brain metabolic changes related to early and delayed secondary injury mechanisms may be used in addition to other neuromonitoring parameters in the critical care management of SAH patients. (3) CMD markers of ischemia may detect delayed cerebral ischemia early (up to 16 h before onset), underlining the importance of trend analysis. (4) Various CMD-derived parameters may be associated with patient outcome at 3–12 months, including CMD-lactate-to-pyruvate-ratio, CMD-glucose, and CMD-glutamate.ConclusionThe clinical use of CMD is an emerging area in the literature of aneurysmal SAH patients. Larger prospective multi-center studies on interventions based on CMD findings are needed.

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Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Clinical Use of Cerebral Microdialysis in Patients with Aneurysmal Subarachnoid Hemorrhage—State of the Art

et al. 2017

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“…CMD markers—such as glucose and L/P ratio—may be good surrogate markers of CBF, and indeed this has recently been confirmed by several clinical studies combining microdiaylsis with brain imaging, both in patients with SAH ( 37 – 39 ) and TBI ( 40 ). A recently published small observational cohort study illustrated the potential value of CMD monitoring to help detecting cerebral hypoperfusion in comatose aSAH patients, in whom, the clinical examination was unreliable ( 37 ). This study stressed the importance of following dynamic trends over time of both CMD L/P ratio and glucose for the timely detection of secondary cerebral ischemic insults.…”

Section: Cmd To Guide Individualized Intensive Care Therapymentioning

confidence: 77%

Cerebral Microdialysis Monitoring to Improve Individualized Neurointensive Care Therapy: An Update of Recent Clinical Data

Carteron¹,

Bouzat

Oddo

2017

Front. Neurol.

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Cerebral microdialysis (CMD) allows bedside semicontinuous monitoring of patient brain extracellular fluid. Clinical indications of CMD monitoring are focused on the management of secondary cerebral and systemic insults in acute brain injury (ABI) patients [mainly, traumatic brain injury (TBI), subarachnoid hemorrhage, and intracerebral hemorrhage (ICH)], specifically to tailor several routine interventions—such as optimization of cerebral perfusion pressure, blood transfusion, glycemic control and oxygen therapy—in the individual patient. Using CMD as clinical research tool has greatly contributed to identify and better understand important post-injury mechanisms—such as energy dysfunction, posttraumatic glycolysis, post-aneurysmal early brain injury, cortical spreading depressions, and subclinical seizures. Main CMD metabolites (namely, lactate/pyruvate ratio, and glucose) can be used to monitor the brain response to specific interventions, to assess the extent of injury, and to inform about prognosis. Recent consensus statements have provided guidelines and recommendations for CMD monitoring in neurocritical care. Here, we summarize recent clinical investigation conducted in ABI patients, specifically focusing on the role of CMD to guide individualized intensive care therapy and to improve our understanding of the complex disease mechanisms occurring in the immediate phase following ABI. Promising brain biomarkers will also be described.

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Anesthesia for Aneurysmal Subarachnoid Hemorrhage

Bruder

Boussen

Velly

2019

Textbook of Neuroanesthesia and Neurocritical Care

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Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage

Cited by 29 publications

References 26 publications

Clinical Use of Cerebral Microdialysis in Patients with Aneurysmal Subarachnoid Hemorrhage—State of the Art

Clinical Use of Cerebral Microdialysis in Patients with Aneurysmal Subarachnoid Hemorrhage—State of the Art

Cerebral Microdialysis Monitoring to Improve Individualized Neurointensive Care Therapy: An Update of Recent Clinical Data

Anesthesia for Aneurysmal Subarachnoid Hemorrhage

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