Abstract
OBJECTIVE: To determine whether pericontusional tissue exhibits neurochemical responsiveness to changes in cerebral perfusion pressure as measured by microdialysis lactate/pyruvate ratio. DESIGN: Prospective monitoring with retrospective data analysis. SETTING: Single-center academic neurologic intensive care unit. PATIENTS: Twenty-one patients with severe traumatic brain injury (Glasgow Coma Scale score 3-8). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Cerebral microdialysis was performed for the initial 7 days after traumatic brain injury. Thirteen patients had microdialysis probes in normal tissue and eight had two probes, one of which was located in pericontusional tissue. Retrospective analysis was performed to determine if microdialysis levels in pericontusional tissue demonstrates higher levels of lactate/pyruvate ratio than normal tissue and if lactate/pyruvate ratio increased with reductions in cerebral perfusion pressure. Univariate analysis revealed higher values for glutamate and lactate/pyruvate ratio in pericontusional tissue compared with normal tissue. However, based on the mixed-effects model analysis, the percent time of elevated lactate/pyruvate ratio was significantly higher in pericontusional tissue (40 ± 59% vs. 17 ± 37%, p < .05), and the mean lactate/pyruvate ratio values showed only a trend relationship (62 ± 134 vs. 34 ± 78, p < .06). When examined by cerebral perfusion pressure threshold, cerebral perfusion pressure <60 mm Hg was not associated with higher lactate/pyruvate ratio values in normal or pericontusional tissue. In addition, no single cerebral perfusion pressure threshold was associated with a significant reduction in lactate/pyruvate ratio in either pericontusional or normal tissue (p < .08). CONCLUSIONS: Sustained increases in lactate/pyruvate ratio occurred more frequently in pericontusional tissue compared with normal brain tissue. The lactate/pyruvate ratio was not related to cerebral perfusion pressure, nor was the percent time-burden of elevated lactate/pyruvate ratio related to any particular sustained cerebral perfusion pressure threshold. Lactate/pyruvate ratio values appear to be elevated despite cerebral perfusion pressure values customarily considered to be adequate.
| Original language | English |
|---|---|
| Pages (from-to) | 1153-1160 |
| Number of pages | 8 |
| Journal | Critical Care Medicine |
| Volume | 35 |
| Issue number | 4 |
| DOIs | |
| State | Published - Apr 1 2007 |
| Externally published | Yes |
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Keywords
- Brain injury
- Cerebral perfusion pressure
- Coma
- Intracranial pressure
- Lactate/pyruvate ratio
- Microdialysis
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
Cite this
Pericontusional brain tissue exhibits persistent elevation of lactate/pyruvate ratio independent of cerebral perfusion pressure. / Vespa, Paul M.; O'Phelan, Kristine H; McArthur, David; Miller, Chad; Eliseo, Matthew; Hirt, Daniel; Glenn, Thomas; Hovda, David A.
In: Critical Care Medicine, Vol. 35, No. 4, 01.04.2007, p. 1153-1160.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Pericontusional brain tissue exhibits persistent elevation of lactate/pyruvate ratio independent of cerebral perfusion pressure
AU - Vespa, Paul M.
AU - O'Phelan, Kristine H
AU - McArthur, David
AU - Miller, Chad
AU - Eliseo, Matthew
AU - Hirt, Daniel
AU - Glenn, Thomas
AU - Hovda, David A.
PY - 2007/4/1
Y1 - 2007/4/1
N2 - OBJECTIVE: To determine whether pericontusional tissue exhibits neurochemical responsiveness to changes in cerebral perfusion pressure as measured by microdialysis lactate/pyruvate ratio. DESIGN: Prospective monitoring with retrospective data analysis. SETTING: Single-center academic neurologic intensive care unit. PATIENTS: Twenty-one patients with severe traumatic brain injury (Glasgow Coma Scale score 3-8). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Cerebral microdialysis was performed for the initial 7 days after traumatic brain injury. Thirteen patients had microdialysis probes in normal tissue and eight had two probes, one of which was located in pericontusional tissue. Retrospective analysis was performed to determine if microdialysis levels in pericontusional tissue demonstrates higher levels of lactate/pyruvate ratio than normal tissue and if lactate/pyruvate ratio increased with reductions in cerebral perfusion pressure. Univariate analysis revealed higher values for glutamate and lactate/pyruvate ratio in pericontusional tissue compared with normal tissue. However, based on the mixed-effects model analysis, the percent time of elevated lactate/pyruvate ratio was significantly higher in pericontusional tissue (40 ± 59% vs. 17 ± 37%, p < .05), and the mean lactate/pyruvate ratio values showed only a trend relationship (62 ± 134 vs. 34 ± 78, p < .06). When examined by cerebral perfusion pressure threshold, cerebral perfusion pressure <60 mm Hg was not associated with higher lactate/pyruvate ratio values in normal or pericontusional tissue. In addition, no single cerebral perfusion pressure threshold was associated with a significant reduction in lactate/pyruvate ratio in either pericontusional or normal tissue (p < .08). CONCLUSIONS: Sustained increases in lactate/pyruvate ratio occurred more frequently in pericontusional tissue compared with normal brain tissue. The lactate/pyruvate ratio was not related to cerebral perfusion pressure, nor was the percent time-burden of elevated lactate/pyruvate ratio related to any particular sustained cerebral perfusion pressure threshold. Lactate/pyruvate ratio values appear to be elevated despite cerebral perfusion pressure values customarily considered to be adequate.
AB - OBJECTIVE: To determine whether pericontusional tissue exhibits neurochemical responsiveness to changes in cerebral perfusion pressure as measured by microdialysis lactate/pyruvate ratio. DESIGN: Prospective monitoring with retrospective data analysis. SETTING: Single-center academic neurologic intensive care unit. PATIENTS: Twenty-one patients with severe traumatic brain injury (Glasgow Coma Scale score 3-8). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Cerebral microdialysis was performed for the initial 7 days after traumatic brain injury. Thirteen patients had microdialysis probes in normal tissue and eight had two probes, one of which was located in pericontusional tissue. Retrospective analysis was performed to determine if microdialysis levels in pericontusional tissue demonstrates higher levels of lactate/pyruvate ratio than normal tissue and if lactate/pyruvate ratio increased with reductions in cerebral perfusion pressure. Univariate analysis revealed higher values for glutamate and lactate/pyruvate ratio in pericontusional tissue compared with normal tissue. However, based on the mixed-effects model analysis, the percent time of elevated lactate/pyruvate ratio was significantly higher in pericontusional tissue (40 ± 59% vs. 17 ± 37%, p < .05), and the mean lactate/pyruvate ratio values showed only a trend relationship (62 ± 134 vs. 34 ± 78, p < .06). When examined by cerebral perfusion pressure threshold, cerebral perfusion pressure <60 mm Hg was not associated with higher lactate/pyruvate ratio values in normal or pericontusional tissue. In addition, no single cerebral perfusion pressure threshold was associated with a significant reduction in lactate/pyruvate ratio in either pericontusional or normal tissue (p < .08). CONCLUSIONS: Sustained increases in lactate/pyruvate ratio occurred more frequently in pericontusional tissue compared with normal brain tissue. The lactate/pyruvate ratio was not related to cerebral perfusion pressure, nor was the percent time-burden of elevated lactate/pyruvate ratio related to any particular sustained cerebral perfusion pressure threshold. Lactate/pyruvate ratio values appear to be elevated despite cerebral perfusion pressure values customarily considered to be adequate.
KW - Brain injury
KW - Cerebral perfusion pressure
KW - Coma
KW - Intracranial pressure
KW - Lactate/pyruvate ratio
KW - Microdialysis
UR - http://www.scopus.com/inward/record.url?scp=34247139821&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34247139821&partnerID=8YFLogxK
U2 - 10.1097/01.CCM.0000259466.66310.4F
DO - 10.1097/01.CCM.0000259466.66310.4F
M3 - Article
VL - 35
SP - 1153
EP - 1160
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 4
ER -