Indian Journal of Neurotrauma 2017; 14(02/03): 122-128
DOI: 10.1055/s-0038-1649283
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Relation between extracellular Chemistry and Patient Outcome for Severe Traumatic Brain Injury within the First 24 hours: A Microdialysis Study

Yutaka Igarashi
1   Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
,
Shoji Yokobori
1   Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
,
Hidetaka Onda
1   Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
,
Tomohiko Masuno
1   Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
,
Hiroyuki Yokota
1   Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

Received: 03 August 2017

Accepted: 20 December 2017

Publication Date:
15 May 2018 (online)

Abstract

Object Many studies have reported that extracellular chemistry is related to the outcome of patients with traumatic brain injury (TBI). No study has reported that extracellular chemistry predicts outcome in less than 3 days. Moreover, in other studies, both focal brain and diffuse brain injuries have been often discussed. The authors focused on the relationship between extracellular chemistry in a shorter period and the outcome of patients with focal brain injury.

Methods By using intracerebral microdialysis monitoring, extracellular fluid concentrations of glucose, lactate, glycerol, glutamate, lactate/pyruvate (L/P), and lactate/glucose (L/G) were determined in 30 patients with severe TBI for initial 24 hours. The results were analyzed between favorable and unfavorable, and between survival and mortality.

Results The medians of glycerol and L/P in the favorable group were significantly lower than those in the unfavorable group (124 µmol/L vs. 808 µmol/L, p = 0.002; 31 vs. 48, p = 0.021, respectively). All parameters apart from glutamate differed significantly between the survival and mortality groups (glucose, 25 mmol/L vs. 77 mmol/L, p = 0.035; lactate, 38 mmol/L vs. 73 mmol/L, p = 0.018; glycerol, 168 µmol/L vs. 1462 µmol/L, p = 0.002; glutamate, 14 µmol/L vs. 95 µmol/L, p = 0.019; L/P, 32 vs. 124, p < 0.001; L/G, 1.46 vs. 4.52, p = 0.004).

Conclusion Cerebral extracellular glycerol and L/P was the most reliable predictor of outcomes in patients with focal brain injury and can discriminate between favorable and unfavorable outcomes for the first 24 hours, using the threshold of 200 and 40, respectively.

 
  • References

  • 1 Andrews PJ, Sleeman DH, Statham PF. et al. Predicting recovery in patients suffering from traumatic brain injury by using admission variables and physiological data: a comparison between decision tree analysis and logistic regression. J Neurosurg 2002; 97 (02) 326-336
  • 2 Jiang JY, Gao GY, Li WP, Yu MK, Zhu C. Early indicators of prognosis in 846 cases of severe traumatic brain injury. J Neurotrauma 2002; 19 (07) 869-874
  • 3 Lingsma HF, Roozenbeek B, Steyerberg EW, Murray GD, Maas AI. Early prognosis in traumatic brain injury: from prophecies to predictions. Lancet Neurol 2010; 9 (05) 543-554
  • 4 Murray GD, Butcher I, McHugh GS. et al. Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study. J Neurotrauma 2007; 24 (02) 329-337
  • 5 Coles JP, Minhas PS, Fryer TD. et al. Effect of hyperventilation on cerebral blood flow in traumatic head injury: clinical relevance and monitoring correlates. Crit Care Med 2002; 30 (09) 1950-1959
  • 6 Diringer MN, Videen TO, Yundt K. et al. Regional cerebrovascular and metabolic effects of hyperventilation after severe traumatic brain injury. J Neurosurg 2002; 96 (01) 103-108
  • 7 Morganti-Kossmann MC, Rancan M, Stahel PF, Kossmann T. Inflammatory response in acute traumatic brain injury: a double-edged sword. Curr Opin Crit Care 2002; 8 (02) 101-105
  • 8 Oertel M, Boscardin WJ, Obrist WD. et al. Posttraumatic vasospasm: the epidemiology, severity, and time course of an underestimated phenomenon: a prospective study performed in 299 patients. J Neurosurg 2005; 103 (05) 812-824
  • 9 Stein SC, Chen XH, Sinson GP, Smith DH. Intravascular coagulation: a major secondary insult in nonfatal traumatic brain injury. J Neurosurg 2002; 97 (06) 1373-1377
  • 10 Vespa P, Bergsneider M, Hattori N. et al. Metabolic crisis without brain ischemia is common after traumatic brain injury: a combined microdialysis and positron emission tomography study. J Cereb Blood Flow Metab 2005; 25 (06) 763-774
  • 11 Persson L, Hillered L. Chemical monitoring of neurosurgical intensive care patients using intracerebral microdialysis. J Neurosurg 1992; 76 (01) 72-80
  • 12 Shigemori M, Abe T, Aruga T. et al Guidelines for the Management of Severe Head Injury, 2nd edition guidelines from the Guidelines Committee on the Management of Severe Head Injury, the Japan Society of Neurotraumatology. Neurol Med Chir (Tokyo) 2012; 52 (01) 1-30
  • 13 Bratton SL, Chestnut RM, Ghajar J. et al; Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons; Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma 2007; 24 (Suppl (01) S37-S44
  • 14 Bellander BM, Cantais E, Enblad P. et al. Consensus meeting on microdialysis in neurointensive care. Intensive Care Med 2004; 30 (12) 2166-2169
  • 15 Marklund N, Salci K, Lewén A, Hillered L. Glycerol as a marker for post-traumatic membrane phospholipid degradation in rat brain. Neuroreport 1997; 8 (06) 1457-1461
  • 16 Clausen T, Alves OL, Reinert M, Doppenberg E, Zauner A, Bullock R. Association between elevated brain tissue glycerol levels and poor outcome following severe traumatic brain injury. J Neurosurg 2005; 103 (02) 233-238
  • 17 Hillered L, Valtysson J, Enblad P, Persson L. Interstitial glycerol as a marker for membrane phospholipid degradation in the acutely injured human brain. J Neurol Neurosurg Psychiatry 1998; 64 (04) 486-491
  • 18 Li AL, Zhi DS, Wang Q, Huang HL. Extracellular glycerol in patients with severe traumatic brain injury. Chin J Traumatol 2008; 11 (02) 84-88
  • 19 Nilsson OG, Brandt L, Ungerstedt U, Säveland H. Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 1999; 45 (05) 1176-1184 discussion 1184–1185
  • 20 Peerdeman SM, Girbes AR, Polderman KH, Vandertop WP. Changes in cerebral interstitial glycerol concentration in head-injured patients; correlation with secondary events. Intensive Care Med 2003; 29 (10) 1825-1828
  • 21 Schulz MK, Wang LP, Tange M, Bjerre P. Cerebral microdialysis monitoring: determination of normal and ischemic cerebral metabolisms in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 2000; 93 (05) 808-814
  • 22 Vespa PM, McArthur D, O'Phelan K. et al. Persistently low extra cellular glucose correlates with poor outcome 6 months after human traumatic brain injury despite a lack of increased lactate: a microdialysis study. J Cereb Blood Flow Metab 2003; 23 (07) 865-877
  • 23 Yokobori S, Watanabe A, Matsumoto G. et al. Lower extracellular glucose level prolonged in elderly patients with severe traumatic brain injury: a microdialysis study. Neurol Med Chir (Tokyo) 2011; 51 (04) 265-271
  • 24 Pellerin L, Magistretti PJ. Glutamate uptake into astrocytes stimulates aerobic glycolysis: a mechanism coupling neuronal activity to glucose utilization. Proc Natl Acad Sci U S A 1994; 91 (22) 10625-10629
  • 25 Bullock R, Zauner A, Myseros JS, Marmarou A, Woodward JJ, Young HF. Evidence for prolonged release of excitatory amino acids in severe human head trauma. Relationship to clinical events. Ann N Y Acad Sci 1995; 765: 290-297 discussion 298
  • 26 Chen T, Qian YZ, Di X, Rice A, Zhu JP, Bullock R. Lactate/glucose dynamics after rat fluid percussion brain injury. J Neurotrauma 2000; 17 (02) 135-142
  • 27 Zauner A, Doppenberg EM, Woodward JJ, Choi SC, Young HF, Bullock R. Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries. Neurosurgery 1997; 41 (05) 1082-1091 discussion 1091–1093
  • 28 Goodman JC, Valadka AB, Gopinath SP, Uzura M, Robertson CS. Extracellular lactate and glucose alterations in the brain after head injury measured by microdialysis. Crit Care Med 1999; 27 (09) 1965-1973
  • 29 Timofeev I, Carpenter KL, Nortje J. et al. Cerebral extracellular chemistry and outcome following traumatic brain injury: a microdialysis study of 223 patients. Brain 2011; 134 (Pt (02) 484-494
  • 30 Vespa PM, O'Phelan K, McArthur D. et al. Pericontusional brain tissue exhibits persistent elevation of lactate/pyruvate ratio independent of cerebral perfusion pressure. Crit Care Med 2007; 35 (04) 1153-1160
  • 31 Persson L, Valtysson J, Enblad P. et al. Neurochemical monitoring using intracerebral microdialysis in patients with subarachnoid hemorrhage. J Neurosurg 1996; 84 (04) 606-616
  • 32 Reinstrup P, Ståhl N, Mellergård P, Uski T, Ungerstedt U, Nordström CH. Intracerebral microdialysis in clinical practice: baseline values for chemical markers during wakefulness, anesthesia, and neurosurgery. Neurosurgery 2000; 47 (03) 701-709 discussion 709–710
  • 33 Bullock R, Zauner A, Woodward JJ. et al. Factors affecting excitatory amino acid release following severe human head injury. J Neurosurg 1998; 89 (04) 507-518