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Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage.
J Neurol Neurosurg Psychiatry. 2017 Apr; 88(4):332-338.JN

Abstract

BACKGROUND

Delayed cerebral ischaemia (DCI) is frequent after poor grade aneurysmal subarachnoid haemorrhage (SAH). Owing to the limited accuracy of clinical examination, DCI diagnosis is often based on multimodal monitoring. We examined the value of cerebral microdialysis (CMD) in this setting.

METHODS

20 comatose SAH participants underwent CMD monitoring-for hourly sampling of cerebral extracellular lactate/pyruvate ratio (LPR) and glucose-and brain perfusion CT (PCT). Patients were categorised as DCI when PCT (8±3 days after SAH) showed cerebral hypoperfusion, defined as cerebral blood flow <32.5 mL/100 g/min with a mean transit time >5.7 s. Clinicians were blinded to CMD data; for the purpose of the study, only patients who developed cerebral hypoperfusion in anterior and/or middle cerebral arteries were analysed.

RESULTS

DCI (n=9/20 patients) was associated with higher CMD LPR (51±36 vs 31±10 in patients without DCI, p=0.0007) and lower CMD glucose (0.64±0.34 vs 1.22±1.05, p=0.0005). In patients with DCI, CMD changes over the 18 hours preceding PCT diagnosis revealed a pattern of CMD LPR increase (coefficient +2.96 (95% CI 0.13 to 5.79), p=0.04) with simultaneous CMD glucose decrease (coefficient -0.06 (95% CI -0.08 to -0.01), p=0.03, mixed-effects multilevel regression model). No significant CMD changes were noted in patients without DCI.

CONCLUSIONS

In comatose patients with SAH, delayed cerebral hypoperfusion correlates with a CMD pattern of lactate increase and simultaneous glucose decrease. CMD abnormalities became apparent in the hours preceding PCT, thereby suggesting that CMD monitoring may anticipate targeted therapeutic interventions.

Authors+Show Affiliations

Neuroscience Critical Care Research Group, Departments of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital, Lausanne, Switzerland.Neuroscience Critical Care Research Group, Departments of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital, Lausanne, Switzerland. Department of Anesthesia and Critical Care, University Hospital, Nice, France.Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital, Lausanne, Switzerland.University of Lausanne, Lausanne, Switzerland.Neuroscience Critical Care Research Group, Departments of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital, Lausanne, Switzerland.Neuroscience Critical Care Research Group, Departments of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital, Lausanne, Switzerland.Department of Anesthesia and Critical Care, University Hospital, Grenoble, France. Neuroscience Institute, Grenoble, France.Division of Neurosurgery, Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital, Lausanne, Switzerland.Division of Neurosurgery, Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital, Lausanne, Switzerland.Division of Neurosurgery, Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital, Lausanne, Switzerland.Neuroscience Critical Care Research Group, Departments of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital, Lausanne, Switzerland.Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital, Lausanne, Switzerland.Neuroscience Critical Care Research Group, Departments of Intensive Care Medicine, Centre Hospitalier Universitaire Vaudois (CHUV)-Lausanne University Hospital, Lausanne, Switzerland.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

27927702

Citation

Patet, Camille, et al. "Bedside Cerebral Microdialysis Monitoring of Delayed Cerebral Hypoperfusion in Comatose Patients With Poor Grade Aneurysmal Subarachnoid Haemorrhage." Journal of Neurology, Neurosurgery, and Psychiatry, vol. 88, no. 4, 2017, pp. 332-338.
Patet C, Quintard H, Zerlauth JB, et al. Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2017;88(4):332-338.
Patet, C., Quintard, H., Zerlauth, J. B., Maibach, T., Carteron, L., Suys, T., Bouzat, P., Bervini, D., Levivier, M., Daniel, R. T., Eckert, P., Meuli, R., & Oddo, M. (2017). Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage. Journal of Neurology, Neurosurgery, and Psychiatry, 88(4), 332-338. https://doi.org/10.1136/jnnp-2016-313766
Patet C, et al. Bedside Cerebral Microdialysis Monitoring of Delayed Cerebral Hypoperfusion in Comatose Patients With Poor Grade Aneurysmal Subarachnoid Haemorrhage. J Neurol Neurosurg Psychiatry. 2017;88(4):332-338. PubMed PMID: 27927702.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage. AU - Patet,Camille, AU - Quintard,Hervé, AU - Zerlauth,Jean-Baptiste, AU - Maibach,Thomas, AU - Carteron,Laurent, AU - Suys,Tamarah, AU - Bouzat,Pierre, AU - Bervini,David, AU - Levivier,Marc, AU - Daniel,Roy T, AU - Eckert,Philippe, AU - Meuli,Reto, AU - Oddo,Mauro, Y1 - 2016/12/07/ PY - 2016/04/13/received PY - 2016/08/09/revised PY - 2016/09/07/accepted PY - 2016/12/9/pubmed PY - 2017/5/18/medline PY - 2016/12/9/entrez SP - 332 EP - 338 JF - Journal of neurology, neurosurgery, and psychiatry JO - J. Neurol. Neurosurg. Psychiatry VL - 88 IS - 4 N2 - BACKGROUND: Delayed cerebral ischaemia (DCI) is frequent after poor grade aneurysmal subarachnoid haemorrhage (SAH). Owing to the limited accuracy of clinical examination, DCI diagnosis is often based on multimodal monitoring. We examined the value of cerebral microdialysis (CMD) in this setting. METHODS: 20 comatose SAH participants underwent CMD monitoring-for hourly sampling of cerebral extracellular lactate/pyruvate ratio (LPR) and glucose-and brain perfusion CT (PCT). Patients were categorised as DCI when PCT (8±3 days after SAH) showed cerebral hypoperfusion, defined as cerebral blood flow <32.5 mL/100 g/min with a mean transit time >5.7 s. Clinicians were blinded to CMD data; for the purpose of the study, only patients who developed cerebral hypoperfusion in anterior and/or middle cerebral arteries were analysed. RESULTS: DCI (n=9/20 patients) was associated with higher CMD LPR (51±36 vs 31±10 in patients without DCI, p=0.0007) and lower CMD glucose (0.64±0.34 vs 1.22±1.05, p=0.0005). In patients with DCI, CMD changes over the 18 hours preceding PCT diagnosis revealed a pattern of CMD LPR increase (coefficient +2.96 (95% CI 0.13 to 5.79), p=0.04) with simultaneous CMD glucose decrease (coefficient -0.06 (95% CI -0.08 to -0.01), p=0.03, mixed-effects multilevel regression model). No significant CMD changes were noted in patients without DCI. CONCLUSIONS: In comatose patients with SAH, delayed cerebral hypoperfusion correlates with a CMD pattern of lactate increase and simultaneous glucose decrease. CMD abnormalities became apparent in the hours preceding PCT, thereby suggesting that CMD monitoring may anticipate targeted therapeutic interventions. SN - 1468-330X UR - https://www.unboundmedicine.com/medline/citation/27927702/Bedside_cerebral_microdialysis_monitoring_of_delayed_cerebral_hypoperfusion_in_comatose_patients_with_poor_grade_aneurysmal_subarachnoid_haemorrhage_ L2 - http://jnnp.bmj.com/cgi/pmidlookup?view=long&amp;pmid=27927702 DB - PRIME DP - Unbound Medicine ER -