Quantitation of Ischemic Events After Severe Traumatic Brain Injury in Humans: A Simple Scoring System

Mazzeo, Anna Teresa; Kunene, Niki K.; Choi, Sung C.; Gilman, Charlotte; Bullock, Ross

doi:10.1097/01.ana.0000210999.18033.f6

Cited by 20 publications

(11 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thirteen studies documented an association between CMD measured glucose and mortality/Glasgow Outcome Scale (GOS) at 3–6 months [ 6 , 9 , 29 , 38 , 48 , 54 , 64 , 66 , 73 , 80 , 105 , 107 , 108 ]. The documented association was that low CMD glucose was associated with patient functional outcome.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome

et al. 2017

View full text Add to dashboard Cite

ObjectiveTo perform a systematic review on commonly measured cerebral microdialysis (CMD) analytes and their association to: (A) patient functional outcome, (B) neurophysiologic measures, and (C) tissue outcome; after moderate/severe TBI. The aim was to provide a foundation for next-generation CMD studies and build on existing pragmatic expert guidelines for CMD.MethodsWe searched MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to October 2016). Strength of evidence was adjudicated using GRADE.Results(A) Functional Outcome: 55 articles were included, assessing outcome as mortality or Glasgow Outcome Scale (GOS) at 3–6 months post-injury. Overall, there is GRADE C evidence to support an association between CMD glucose, glutamate, glycerol, lactate, and LPR to patient outcome at 3–6 months. (B) Neurophysiologic Measures: 59 articles were included. Overall, there currently exists GRADE C level of evidence supporting an association between elevated CMD measured mean LPR, glutamate and glycerol with elevated ICP and/or decreased CPP. In addition, there currently exists GRADE C evidence to support an association between elevated mean lactate:pyruvate ratio (LPR) and low PbtO2. Remaining CMD measures and physiologic outcomes displayed GRADE D or no evidence to support a relationship. (C) Tissue Outcome: four studies were included. Given the conflicting literature, the only conclusion that can be drawn is acute/subacute phase elevation of CMD measured LPR is associated with frontal lobe atrophy at 6 months.ConclusionsThis systematic review replicates previously documented relationships between CMD and various outcome, which have driven clinical application of the technique. Evidence assessments do not address the application of CMD for exploring pathophysiology or titrating therapy in individual patients, and do not account for the modulatory effect of therapy on outcome, triggered at different CMD thresholds in individual centers. Our findings support clinical application of CMD and refinement of existing guidelines.Electronic supplementary materialThe online version of this article (10.1007/s00701-017-3338-2) contains supplementary material, which is available to authorized users.

show abstract

Section: Resultsmentioning

confidence: 99%

A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome

et al. 2017

View full text Add to dashboard Cite

show abstract

“…This secondary damage is the result of a sequence of events that can include: disruption of the normal regulation of cerebral inflow and outflow, often resulting in cerebral hyperaemia; increased transmural pressure in capillary beds causing tissue hypoxia, elevated levels of CO 2 and a reduction in extravascular fluid resorption; tissue acidosis; metabolic dysfunction; microthrombus formation; secondary inflammation, and damage to the blood-brain barrier, all of which increase cerebral oedema and cause further increases in ICP [32,33,34,35,36,37,38,39,40,41,42,43]. The brain of a child, and particularly of a young child, may be particularly susceptible to these pathophysiological changes.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Decompressive Craniectomy for Refractory Intracranial Hypertension in a Child with Severe ITP-Related Intracerebral Haemorrhage

Ranger

Szymczak²,

Fraser³

et al. 2009

Pediatr Neurosurg

View full text Add to dashboard Cite

We report a 13-month-old infant who developed acutely elevated intracranial pressure (ICP) as a result of a spontaneous intracerebral haemorrhage (ICH), secondary to idiopathic thrombocytopenic purpura (ITP). Her ICP remained severely elevated despite aggressive medical measures, with persistent obtundation, right hemiparesis and a dilated left pupil. Bilateral decompressive craniectomies (DCs) were performed, which resulted in a rapid decline in ICP. Ultimately, the patient regained consciousness and went on to complete neurological recovery. Tragically, she died of non-neurological, ITP-related complications 9 months later. In our review, we identified no other instances of bilateral DCs reported in the management of an infant with ITP and/or an ICH. We addressed three central questions: (1) Is there any value of DCs in children, and especially in infants, with elevated ICP? (2) Is there any value of DCs in the setting of non-traumatic ICH? And (3) is there any rationale for the use of bilateral versus unilateral DCs?

show abstract

“…Furthermore, in a large population of TBI patients, Bullock and coworkers demonstrated that the results of microdialysisbased neurochemical monitoring correlate with quantitation of ischemic events, as measured by a simple five-item scoring system, taking into account the occurrence of specific potentially brain-damaging events (hypoxemia, hypotension, low cerebral blood flow, herniation, and low CPP). 14 Recently, in a population of TBI patients undergoing spreading depolarization (SD) monitoring, with electrocorticography, the association of SD and neurochemical markers as measured by microdialysis were studied. 15 The authors showed that extracellular glutamate (50 µmol/L) and lactate (3.7 mmol/L) were significantly elevated on day 0 in patients with SD.…”

Section: Microdialysis As a Measure Of Brain Energy Metabolism Alteramentioning

confidence: 99%

Cerebral Microdialysis: Going Deep into Brain Biochemistry for a Better Understanding of Pathomechanisms of Acute Brain Injury

Gupta

Mazzeo

2017

IJNS

View full text Add to dashboard Cite

Patients with traumatic brain injury (TBI) have variable outcomes subject to intracranial hypertension, ischemia, hypotension, and various biochemical alterations. Multimodality neurointensive monitoring is standard of care for decision making in all severe TBI cases at present in most neurotrauma units. Neuromonitoring tools, such as cerebral microdialysis, may contribute to understanding the pathomechanisms of acute brain injury, provide an early warning of secondary cerebral deterioration (therapeutic window of opportunity), and help in selecting the patients most suitable to benefit from this very invasive surgical rescue therapy. Cerebral microdialysis can be used as a measure of the effect of decompressive craniectomy on neurochemistry derangement and brain energy crisis jeopardizing the injured brain. Present review discusses the cerebral microdialysis, its usefulness, and role in prognostication of severe TBIs, especially in patients post-decompressive craniectomy. The authors also discuss the current consensus guidelines on usage of cerebral microdialysis in TBI patients.

show abstract

Quantitation of Ischemic Events After Severe Traumatic Brain Injury in Humans: A Simple Scoring System

Abstract: The ischemic score proposed here, may be determined during the acute intensive care unit period, and correlates closely with outcome, which can only be determined 3 to 6 months, after injury. It also shows a correlation with neurochemical analytes.

Cited by 20 publications

References 62 publications

A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome

A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome

Bilateral Decompressive Craniectomy for Refractory Intracranial Hypertension in a Child with Severe ITP-Related Intracerebral Haemorrhage

Cerebral Microdialysis: Going Deep into Brain Biochemistry for a Better Understanding of Pathomechanisms of Acute Brain Injury

Contact Info

Product

Resources

About