Consensus statement from the 2014 International Microdialysis Forum

Abstract

Microdialysis enables the chemistry of the extracellular interstitial space to be monitored. Use of this technique in patients with acute brain injury has increased our understanding of the pathophysiology of several acute neurological disorders. In 2004, a consensus document on the clinical application of cerebral microdialysis was published. Since then, there have been significant advances in the clinical use of microdialysis in neurocritical care. The objective of this review is to report on the International Microdialysis Forum held in Cambridge, UK, in April 2014 and to produce a revised and updated consensus statement about its clinical use including technique, data interpretation, relationship with outcome, role in guiding therapy in neurocritical care and research applications.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-015-3930-y) contains supplementary material, which is available to authorized users.

Unraveling the complexities of invasive multimodality neuromonitoring

“…26,61 A double-lumen catheter surrounded by a semipermeable membrane is inserted into parenchymal tissue. Isotonic artificial CSF is continuously cycled into the inlet lumen and removed from the outlet lumen at a constant rate.…”

“…Calculating the ratio of recovered analytes (such as lactate:pyruvate) normalizes for differences in analyte recovery and facilitates serial comparisons over time. 26,61 Hourly sampling is typically used for clinical care; however, rapid sampling 3 and microfluidic methods 47 have been developed that enable essentially continuous measurements.…”

“…These biochemical signatures of metabolic distress both predict poor outcome. They can occur both in response to decreases in cerebral perfusion 9,24,26,52,54,60,61 and when CBF is normal. 56,64,70 "Nonischemic" metabolic crises are probably due to injury-associated mitochondrial dysfunction, which reduces the brain's ability to use oxygen and triggers compensatory hyperglycolysis.…”

Focus on clinical neuroscience

“…Recent guidance highlights the importance of multimodal neuromonitoring to guide an individualized approach to patient management based on monitored physiological variables rather than pre-determined, generic thresholds [2]. This concept also applies to cerebral microdialysis monitoring, the guidance for which has been revised and updated [4]. Novel non-invasive neuromonitoring techniques would be advantageous when invasive monitoring is contraindicated.…”

The editorial policy of Intensive Care Medicine

“…Properly registered and high-quality systematic reviews and meta-analyses are also frequently published [3]. ICM seeks to publish current and hot topics [4][5][6], new developments, educational materials (Guidelines, Statements, Expert Opinions) [7,8] and lessons from other settings [9]. ICM has unique submission tracks that offer updated information on specific topics (What's New…) [10,11], insight into complex pathophysiology (Understanding the Disease) [11], or more personal thoughts (From the Inside) [12].…”