BACKGROUND: Intracerebral microdialysis (MD) was applied in patients with severe subarachnoid haemorrhage treated in a neurosurgical intensive care unit in order to explore their cerebral energy metabolism. METHOD: Brain MD fluid levels of glucose, lactate and pyruvate were measured for 3 to 12 days in 20 patients and 2,635 hourly samples were analysed. The MD data were related to computerized tomography and clinical outcome, assessed by the Glasgow Outcome Scale. FINDINGS: The study showed that most patients who made a good recovery had a specific curve pattern when plotting the studied metabolites over time, characterised by a distinct decrease in MD-glucose and a parallel increase in both MD-lactate and pyruvate. Patients who had an unfavourable outcome lacked this distinct curve pattern and exhibited more irregular changes, including increased levels of both MD-glucose and lactate and low MD-pyruvate levels. INTERPRETATION: This exploratory study suggests that accumulation of interstitial lactate and pyruvate, together with decreasing levels of glucose is a favourable prognostic pattern presumably reflecting increased glucose metabolism. Such hyperglycolysis may be elicited in patients with recovery potential to cope with an extreme metabolic demand set in motion by a brain insult to restore brain cell homeostasis and integrity.
BACKGROUND: Intracerebral microdialysis (MD) was applied in patients with severe subarachnoid haemorrhage treated in a neurosurgical intensive care unit in order to explore their cerebral energy metabolism. METHOD: Brain MD fluid levels of glucose, lactate and pyruvate were measured for 3 to 12 days in 20 patients and 2,635 hourly samples were analysed. The MD data were related to computerized tomography and clinical outcome, assessed by the Glasgow Outcome Scale. FINDINGS: The study showed that most patients who made a good recovery had a specific curve pattern when plotting the studied metabolites over time, characterised by a distinct decrease in MD-glucose and a parallel increase in both MD-lactate and pyruvate. Patients who had an unfavourable outcome lacked this distinct curve pattern and exhibited more irregular changes, including increased levels of both MD-glucose and lactate and low MD-pyruvate levels. INTERPRETATION: This exploratory study suggests that accumulation of interstitial lactate and pyruvate, together with decreasing levels of glucose is a favourable prognostic pattern presumably reflecting increased glucose metabolism. Such hyperglycolysis may be elicited in patients with recovery potential to cope with an extreme metabolic demand set in motion by a brain insult to restore brain cell homeostasis and integrity.
Authors: Pedro Kurtz; Jan Claassen; J Michael Schmidt; Raimund Helbok; Khalid A Hanafy; Mary Presciutti; Hector Lantigua; E Sander Connolly; Kiwon Lee; Neeraj Badjatia; Stephan A Mayer Journal: Neurocrit Care Date: 2013-12 Impact factor: 3.210
Authors: Peter J Hutchinson; Ibrahim Jalloh; Adel Helmy; Keri L H Carpenter; Elham Rostami; Bo-Michael Bellander; Martyn G Boutelle; Jeff W Chen; Jan Claassen; Claire Dahyot-Fizelier; Per Enblad; Clare N Gallagher; Raimund Helbok; Lars Hillered; Peter D Le Roux; Sandra Magnoni; Halinder S Mangat; David K Menon; Carl-Henrik Nordström; Kristine H O'Phelan; Mauro Oddo; Jon Perez Barcena; Claudia Robertson; Elisabeth Ronne-Engström; Juan Sahuquillo; Martin Smith; Nino Stocchetti; Antonio Belli; T Adrian Carpenter; Jonathan P Coles; Marek Czosnyka; Nil Dizdar; J Clay Goodman; Arun K Gupta; Troels H Nielsen; Niklas Marklund; Ambroise Montcriol; Mark T O'Connell; Maria A Poca; Asita Sarrafzadeh; Richard J Shannon; Jane Skjøth-Rasmussen; Peter Smielewski; John F Stover; Ivan Timofeev; Paul Vespa; Elizabeth Zavala; Urban Ungerstedt Journal: Intensive Care Med Date: 2015-09 Impact factor: 17.440