Cerebral energy failure after subarachnoid hemorrhage: The role of relative hyperglycolysis

Oertel, Matthias F.; Schwedler, Madlen; Stein, Marco; Wachter, Dorothee; Scharbrodt, Wolfram; Schmidinger, A.; Böker, Dieter-Karsten

doi:10.1016/j.jocn.2006.11.002

Cited by 15 publications

(16 citation statements)

References 31 publications

(36 reference statements)

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“…Review of the available literature documents the efflux of lactate with CEA or during cerebral injury as being potentially important to indicate brain-at-risk -but not the converse. 9,[17][18][19] Our findings are controversial, but new work strongly suggests that lactate may well be the preferred substrate for cerebral metabolism both anerobically and aerobically. [20][21][22][23] Thus, in the face of diminished oxygen supply, as with carotid cross-clamping in patients at risk, influx of lactate may be critically important to serve as a fuel for cerebral metabolism.…”

Section: Discussionmentioning

confidence: 77%

“…6 shows the decreased ratio of arterial-jugular venous O 2 utilization to arterial-jugular venous glucose utilization (termed the hyperglycolytic index if the ratio is \ 3.44). 17 Density spectral analysis during CEA and lactate flux When carotid cross-clamping was associated with evidence of more than a single demonstration of lactate influx with carotid cross-clamping, diminution of high frequency EEG signals could be demonstrated (see Fig. 3B for such a patient).…”

Section: Resultsmentioning

confidence: 99%

“…Oertel et al 17 showed that there was nearly a 50% mortality rate if this ratio was \ 3.44 (termed hyperglycolysis). Fig .…”

Section: Discussionmentioning

confidence: 99%

“…Above the figure is a contingency table of the incidence of each flux state for values for the DO 2 content to Dglucose ratio of \ 3.44 (defined as hyperglycolysis). 17 state was seen with lactate influx over 60% of the time, suggesting the brain was under metabolic stress. This study has demonstrated that the measurement of lactate flux is not difficult.…”

Section: Discussionmentioning

confidence: 99%

“…Lactate differences were normalized based on arterial concentration, i.e., an index was reported based on arterial-jugular venous concentration/arterial concentration. The hyperglycolytic index 17 was determined by calculation of Darterial-jugular venous O 2 content (mmoLÁL -1 )/D arterial-jugular venous glucose concentration (mmoLÁL -1 ).…”

Section: Data Collectionmentioning

confidence: 99%

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Lactate flux during carotid endarterectomy under general anesthesia: correlation with various point-of-care monitors

Espenell

McIntyre

Gulati

et al. 2010

Can J Anesth/J Can Anesth

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Purpose The ability to assess the brain-at-risk during carotid endarterectomy (CEA) under general anesthesia remains a major clinical problem. Point-of-care monitoring can potentially dictate changes to management intraoperatively. In this observational study, we examined the correlation between a series of point-of-care monitors and lactate flux during CEA. Methods Both neurosurgeons and vascular surgeons participated in the study. The patients underwent arterialjugular venous blood sampling for oxygen, carbon dioxide, glucose, and lactate, n = 26; bispectral index (BIS) monitoring ipsilateral to side of surgery, n = 26; raw and processed electroencephalogram (EEG), n = 22; and bi-frontal cerebral oximetry using the Fore-Sight monitor, n = 20. Results One patient experienced a new neurological deficit when assessed at 24 hr following surgery. Lactate flux into the brain was correlated with the greatest decrease in cerebral oximetry with carotid cross-clamping; lactate efflux was correlated with the least. The most noticeable changes in processed EEG (density spectral analysis) were also seen with lactate influx, but at a slower time resolution than cerebral oximetry. Loss of autoregulatory behaviour was demonstrated with lactate influx; however, no correlation was seen between lactate flux and BIS monitoring. Conclusion There was a correlation between cerebral oximetry and lactate flux during carotid cross-clamping. The Fore-Sight monitor may be of value as a point-of-care monitor during CEA under general anesthesia. A novel finding of this study is lactate flux into the brain in the presence of a large difference in cerebral oxygenation during cross-clamping of the carotid artery. Registered at clinicaltrials.gov: NCT000737334. RésuméObjectif La capacite´d'e´valuer le cerveau a`risque pendant une endarte´riectomie carotidienne (EC) sous anesthe´sie ge´ne´rale demeure un proble`me clinique important. Le monitorage au chevet pourrait potentiellement conduire ad es modifications de la prise en charge perope´ratoire. Dans cette e´tude observationnelle, nous avons explore´la corre´lation entre une se´rie de moniteurs au chevet et le flux de lactate pendant une EC. Méthode Des neurochirurgiens et des chirurgiens vasculaires ont pris part a`cette e´tude. Les patients ont subi un e´chantillonnage du sang veineux arte´riel jugulaire pour de´tecter les concentrations d'oxyge`ne, de dioxyde de carbone, de glucose et de lactate, n = 26; monitorage par index bispectral (BIS) ipsilate´ral au côte´de la chirurgie, n = 26; e´lectroence´phalogramme (EEG) brut et apre`s

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Section: Discussionmentioning

confidence: 77%

Section: Resultsmentioning

confidence: 99%

“…Oertel et al 17 showed that there was nearly a 50% mortality rate if this ratio was \ 3.44 (termed hyperglycolysis). Fig .…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

See 3 more Smart Citations

Lactate flux during carotid endarterectomy under general anesthesia: correlation with various point-of-care monitors

Espenell

McIntyre

Gulati

et al. 2010

Can J Anesth/J Can Anesth

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Cerebrospinal Fluid Lactate Concentration After Withdrawal of Metabolic Suppressive Therapy in Subarachnoid Hemorrhage

Stein

Schomacher

Scharbrodt

et al. 2012

Acta Neurochirurgica Supplementum

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Hyperglycolysis is a known phenomenon after severe subarachnoid hemorrhage (SAH) and after brain injury. It is characterized by decreased oxidative metabolism and relatively increased anaerobic glycolysis. Metabolic suppressive therapy reduces the cerebral metabolic rate of oxygen (CMRO(2)) and the cerebral metabolic rate of glucose (CMRGluc). If CMRO(2) is suppressed after SAH, withdrawal of metabolic suppressive therapy could lead to the accumulation of lactate. In this project, we assessed the relationship between the withdrawal of metabolic suppressive therapy and cerebrospinal fluid (CSF) lactate concentration. A prospective observational database containing 262 patients with SAH was retrospectively analyzed. CSF lactate levels were compared with the daily dose of metabolic suppressive therapy. Outcome was assessed with the Glasgow Outcome Scale (GOS). In 56% of patients an increase in CSF lactate (mean: 3.2 ± 0.9 mmol/L) after withdrawal of metabolic suppressive therapy was observed. Mean Glasgow Outcome Score (GOS) was lower in patients with an increase in CSF lactate concentration (>0.5 mmol/L) after withdrawal of metabolic suppressive therapy (p = 0.095). In 88% of patients who died during the first 30 days after SAH, a CSF lactate elevation of more than 0.5 mmol/L after withdrawal of metabolic suppressive therapy was found (p = 0.071).

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Hyperglycemia and cerebral glucose in aneurysmal subarachnoid hemorrhage

et al. 2008

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Although hyperglycemia was more frequent in symptomatic patients and associated with high glycerol levels, hyperglycemia was not related to cerebral high glucose. It appears that the association of adverse outcome with acute-phase hyperglycemia is not mediated by cerebral glucose metabolism. Cerebral low glucose was associated with severe metabolic distress and may present a target for therapy to improve clinical outcome.

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Cerebral energy failure after subarachnoid hemorrhage: The role of relative hyperglycolysis

Cited by 15 publications

References 31 publications

Lactate flux during carotid endarterectomy under general anesthesia: correlation with various point-of-care monitors

Lactate flux during carotid endarterectomy under general anesthesia: correlation with various point-of-care monitors

Cerebrospinal Fluid Lactate Concentration After Withdrawal of Metabolic Suppressive Therapy in Subarachnoid Hemorrhage

Hyperglycemia and cerebral glucose in aneurysmal subarachnoid hemorrhage

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