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Microdialysis Monitoring of CSF Parameters in Severe Traumatic Brain Injury Patients: A Novel Approach.

Thelin EP, Nelson DW, Ghatan PH, Bellander BM - Front Neurol (2014)

Bottom Line: Median MD-CSF (CMA 64) lactate (p = 0.0057) and pyruvate (p = 0.0011) levels were significantly lower in the favorable outcome group compared to the unfavorable group.No significant difference in outcome was found using the lactate:pyruvate ratio (LPR), or any of the regional MD-Brain monitoring in our analyzed cohort.Increase in lactate and pyruvate, without any effect on the LPR, correlates to unfavorable outcome, perhaps related to the presence of erythrocytes in the CSF.

View Article: PubMed Central - PubMed

Affiliation: Section for Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Solna , Stockholm , Sweden.

ABSTRACT

Background: Neuro-intensive care following traumatic brain injury (TBI) is focused on preventing secondary insults that may lead to irreversible brain damage. Microdialysis (MD) is used to detect deranged cerebral metabolism. The clinical usefulness of the MD is dependent on the regional localization of the MD catheter. The aim of this study was to analyze a new method of continuous cerebrospinal fluid (CSF) monitoring using the MD technique. The method was validated using conventional laboratory analysis of CSF samples. MD-CSF and regional MD-Brain samples were correlated to patient outcome.

Materials and methods: A total of 14 patients suffering from severe TBI were analyzed. They were monitored using (1) a MD catheter (CMA64-iView, n = 7448 MD samples) located in a CSF-pump connected to the ventricular drain and (2) an intraparenchymal MD catheter (CMA70, n = 8358 MD samples). CSF-lactate and CSF-glucose levels were monitored and were compared to MD-CSF samples. MD-CSF and MD-Brain parameters were correlated to favorable (Glasgow Outcome Score extended, GOSe 6-8) and unfavorable (GOSe 1-5) outcome.

Results: Levels of glucose and lactate acquired with the CSF-MD technique could be correlated to conventional levels. The median MD recovery using the CMA64 catheter in CSF was 0.98 and 0.97 for glucose and lactate, respectively. Median MD-CSF (CMA 64) lactate (p = 0.0057) and pyruvate (p = 0.0011) levels were significantly lower in the favorable outcome group compared to the unfavorable group. No significant difference in outcome was found using the lactate:pyruvate ratio (LPR), or any of the regional MD-Brain monitoring in our analyzed cohort.

Conclusion: This new technique of global MD-CSF monitoring correlates with conventional CSF levels of glucose and lactate, and the MD recovery is higher than previously described. Increase in lactate and pyruvate, without any effect on the LPR, correlates to unfavorable outcome, perhaps related to the presence of erythrocytes in the CSF.

No MeSH data available.


Related in: MedlinePlus

The monitoring setup, illustrating the CMA 64 MD catheter in a closed system of flowing CSF.
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Figure 1: The monitoring setup, illustrating the CMA 64 MD catheter in a closed system of flowing CSF.

Mentions: A 20 kDa cutoff cerebral MD catheter (CMA 70, 10 mm membrane, μ-dialysis AB, Stockholm, Sweden) was inserted into the brain parenchyma, adjacent to the ventricular drain in the affected hemisphere in a diffuse brain injury or when further craniotomy was not performed, or next to the lesion in a focal brain injury, during the initial neurosurgery at admission. Post-surgery at the NICU, the MD catheter was connected to a MD pump (CMA 106, μ-dialysis AB, Stockholm, Sweden) where a commercially available perfusion fluid (“Perfusion Fluid CNS”, μ-dialysis AB, Stockholm, Sweden), pumped at 0.3 μL/min, was used as carrier for all MD metabolites. Another 20 kDa cut off catheter (CMA 64 iView, 10 mm membrane, μ-dialysis AB, Stockholm, Sweden), with a CMA 106 MD pump, was placed inside a four-way stopcock (Multiflo 3, BD Connecta, Franklin Lakes, NJ, USA) (Figure 1), connected to the LiquoGuard® CSF-pump, located in the draining CSF at all times. Membrane length and dialysis perfusion flow rate are factors known to affect recovery and were thus standardized for all catheters used (37). The CMA64 catheter has, when placed in a peripheral vein, shown an adequate congruence (80% MD recovery) between CMA64 MD-glucose and plasma glucose levels (38, 39).


Microdialysis Monitoring of CSF Parameters in Severe Traumatic Brain Injury Patients: A Novel Approach.

Thelin EP, Nelson DW, Ghatan PH, Bellander BM - Front Neurol (2014)

The monitoring setup, illustrating the CMA 64 MD catheter in a closed system of flowing CSF.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4151035&req=5

Figure 1: The monitoring setup, illustrating the CMA 64 MD catheter in a closed system of flowing CSF.
Mentions: A 20 kDa cutoff cerebral MD catheter (CMA 70, 10 mm membrane, μ-dialysis AB, Stockholm, Sweden) was inserted into the brain parenchyma, adjacent to the ventricular drain in the affected hemisphere in a diffuse brain injury or when further craniotomy was not performed, or next to the lesion in a focal brain injury, during the initial neurosurgery at admission. Post-surgery at the NICU, the MD catheter was connected to a MD pump (CMA 106, μ-dialysis AB, Stockholm, Sweden) where a commercially available perfusion fluid (“Perfusion Fluid CNS”, μ-dialysis AB, Stockholm, Sweden), pumped at 0.3 μL/min, was used as carrier for all MD metabolites. Another 20 kDa cut off catheter (CMA 64 iView, 10 mm membrane, μ-dialysis AB, Stockholm, Sweden), with a CMA 106 MD pump, was placed inside a four-way stopcock (Multiflo 3, BD Connecta, Franklin Lakes, NJ, USA) (Figure 1), connected to the LiquoGuard® CSF-pump, located in the draining CSF at all times. Membrane length and dialysis perfusion flow rate are factors known to affect recovery and were thus standardized for all catheters used (37). The CMA64 catheter has, when placed in a peripheral vein, shown an adequate congruence (80% MD recovery) between CMA64 MD-glucose and plasma glucose levels (38, 39).

Bottom Line: Median MD-CSF (CMA 64) lactate (p = 0.0057) and pyruvate (p = 0.0011) levels were significantly lower in the favorable outcome group compared to the unfavorable group.No significant difference in outcome was found using the lactate:pyruvate ratio (LPR), or any of the regional MD-Brain monitoring in our analyzed cohort.Increase in lactate and pyruvate, without any effect on the LPR, correlates to unfavorable outcome, perhaps related to the presence of erythrocytes in the CSF.

View Article: PubMed Central - PubMed

Affiliation: Section for Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Solna , Stockholm , Sweden.

ABSTRACT

Background: Neuro-intensive care following traumatic brain injury (TBI) is focused on preventing secondary insults that may lead to irreversible brain damage. Microdialysis (MD) is used to detect deranged cerebral metabolism. The clinical usefulness of the MD is dependent on the regional localization of the MD catheter. The aim of this study was to analyze a new method of continuous cerebrospinal fluid (CSF) monitoring using the MD technique. The method was validated using conventional laboratory analysis of CSF samples. MD-CSF and regional MD-Brain samples were correlated to patient outcome.

Materials and methods: A total of 14 patients suffering from severe TBI were analyzed. They were monitored using (1) a MD catheter (CMA64-iView, n = 7448 MD samples) located in a CSF-pump connected to the ventricular drain and (2) an intraparenchymal MD catheter (CMA70, n = 8358 MD samples). CSF-lactate and CSF-glucose levels were monitored and were compared to MD-CSF samples. MD-CSF and MD-Brain parameters were correlated to favorable (Glasgow Outcome Score extended, GOSe 6-8) and unfavorable (GOSe 1-5) outcome.

Results: Levels of glucose and lactate acquired with the CSF-MD technique could be correlated to conventional levels. The median MD recovery using the CMA64 catheter in CSF was 0.98 and 0.97 for glucose and lactate, respectively. Median MD-CSF (CMA 64) lactate (p = 0.0057) and pyruvate (p = 0.0011) levels were significantly lower in the favorable outcome group compared to the unfavorable group. No significant difference in outcome was found using the lactate:pyruvate ratio (LPR), or any of the regional MD-Brain monitoring in our analyzed cohort.

Conclusion: This new technique of global MD-CSF monitoring correlates with conventional CSF levels of glucose and lactate, and the MD recovery is higher than previously described. Increase in lactate and pyruvate, without any effect on the LPR, correlates to unfavorable outcome, perhaps related to the presence of erythrocytes in the CSF.

No MeSH data available.


Related in: MedlinePlus