Acta Neurochirurgica

, Volume 149, Issue 7, pp 691–698

Neurochemical monitoring using intracerebral microdialysis during systemic haemorrhage

  • P. Meybohm
  • E. Cavus
  • B. Bein
  • M. Steinfath
  • B. Weber
  • J. Scholz
  • V. Doerges
Experimental Research

Summary

Background. Intracerebral microdialysis is a sensitive tool to analyse tissue biochemistry, but the value of this technique to monitor cerebral metabolism during systemic haemorrhage is unknown. The present study was designed to assess changes of intracerebral microdialysis parameters both during systemic haemorrhage and after initiation of therapy.

Methods. Following approval of the Animal Investigational Committee, 18 healthy pigs underwent a penetrating liver trauma. Following haemodynamic decompensation, all animals received a hypertonic-hyperoncotic solution and either norepinephrine or arginine vasopressin, and bleeding was subsequently controlled. Extracellular cerebral concentrations of glucose (Glu), lactate (La), glycerol (Gly), and the lactate/pyruvate ratio (La/Py ratio) were assessed by microdialysis. Cerebral venous protein S-100B was determined. Haemodynamic data, blood gases, S-100B, and microdialysis variables were determined at baseline, at haemodynamic decompensation, and repeated after drug administration.

Results. Microdialysis measurements showed an increase of La, Gly, and La/Py ratio at BL Th compared to BL (mean ± SEM; La 2.4 ± 0.2 vs. 1.4 ± 0.2 mmol · l, p < 0.01; Gly 37 ± 7 vs. 27 ± 6 µmol · l, n.s.; La/Py ratio 50 ± 8 vs. 30 ± 4, p < 0.01), followed by a further increase during the therapy phase (La 3.4 ± 0.3 mmol · l; Gly 69 ± 10 µmol · l; La/Py ratio 58 ± 8; p < 0.001, respectively). Cerebral venous protein S-100B increased at decompensation and after therapy, but decreased close to baseline values after 90 min of therapy.

Conclusions. In this model of systemic haemorrhage, changes of cerebral energy metabolism detected by intracerebral microdialysis indicated anaerobic glycolysis and degradation of cellular membranes throughout the study period.

Keywords: Cerebral ischaemia; microdialysis; systemic haemorrhage; lactate 

Abbreviations

art

arterial

CO

cardiac output

CPP

cerebral perfusion pressure

cv

cerebral venous

CVP

central venous pressure

FiO2

fraction of inspired oxygen

Glu

glucose

Gly

glycerol

ICP

intracranial pressure

La

lactate

La/Py ratio

lactate/pyruvate ratio

MAP

mean arterial blood pressure

p(cv-a)CO2

cerebral venous — arterial partial pressure difference of carbon dioxide

SjO2

jugular venous oxygen saturation

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bahlmann, L, Klaus, S, Baumeier, W, Schmucker, P, Raedler, C, Schmittinger, CA, Wenzel, V, Voelckel, W, Lindner, KH 2003Brain metabolism during cardiopulmonary resuscitation assessed with microdialysisResuscitation59255260CrossRefPubMedGoogle Scholar
  2. Bellander, BM, Cantais, E, Enblad, P, Hutchinson, P, Nordstrom, CH, Robertson, C, Sahuquillo, J, Smith, M, Stocchetti, N, Ungerstedt, U, Unterberg, A, Olsen, NV 2004Consensus meeting on microdialysis in neurointensive careIntensive Care Med3021662169CrossRefPubMedGoogle Scholar
  3. Bottiger, BW, Mobes, S, Glatzer, R, Bauer, H, Gries, A, Bartsch, P, Motsch, J, Martin, E 2001Astroglial protein S-100 is an early and sensitive marker of hypoxic brain damage and outcome after cardiac arrest in humansCirculation10326942698PubMedGoogle Scholar
  4. Chen, RY, Fan, FC, Schuessler, GB, Simchon, S, Kim, S, Chien, S 1984Regional cerebral blood flow and oxygen consumption of the canine brain during hemorrhagic hypotensionStroke15343350PubMedGoogle Scholar
  5. Cruz, J 1993Cerebral oxygenation. Monitoring and managementActa Neurochir Suppl (Wien)598690Google Scholar
  6. Enblad, P, Valtysson, J, Andersson, J, Lilja, A, Valind, S, Antoni, G, Langstrom, B, Hillered, L, Persson, L 1996Simultaneous intracerebral microdialysis and positron emission tomography in the detection of ischemia in patients with subarachnoid haemorrhageJ Cereb Blood Flow Metab16637644CrossRefPubMedGoogle Scholar
  7. Foerch, C, Otto, B, Singer, OC, Neumann-Haefelin, T, Yan, B, Berkefeld, J, Steinmetz, H, Sitzer, M 2004Serum S100B predicts a malignant course of infarction in patients with acute middle cerebral artery occlusionStroke3521602164CrossRefPubMedGoogle Scholar
  8. Frykholm, P, Hillered, L, Langstrom, B, Persson, L, Valtysson, J, Watanabe, Y, Enblad, P 2001Increase of interstitial glycerol reflects the degree of ischaemic brain damage: a PET and microdialysis study in a middle cerebral artery occlusion-reperfusion primate modelJ Neurol Neurosurg Psychiatry71455461CrossRefPubMedGoogle Scholar
  9. Ghoshal, NG, Zguigal, H 1986Dural sinuses in the pig and their extracranial venous connectionsAm J Vet Res4711651169PubMedGoogle Scholar
  10. Hillered, L, Valtysson, J, Enblad, P, Persson, L 1998Interstitial glycerol as a marker for membrane phospholipid degradation in the acutely injured human brainJ Neurol Neurosurg Psychiatry64486491CrossRefPubMedGoogle Scholar
  11. Hillered, L, Vespa, PM, Hovda, DA 2005Translational neurochemical research in acute human brain injury: the current status and potential future for cerebral microdialysisJ Neurotrauma22341CrossRefPubMedGoogle Scholar
  12. Hutchinson, PJ, O’Connell, MT, Al-Rawi, PG, Maskell, LB, Kett-White, R, Gupta, AK, Richards, HK, Hutchinson, DB, Kirkpatrick, PJ, Pickard, JD 2000Clinical cerebral microdialysis: a methodological studyJ Neurosurg933743CrossRefPubMedGoogle Scholar
  13. Hutchinson, PJ, O’Connell, MT, Nortje, J, Smith, P, Al-Rawi, PG, Gupta, AK, Menon, DK, Pickard, JD 2005Cerebral microdialysis methodology–evaluation of 20–kDa and 100–kDa cathetersPhysiol Meas26423428CrossRefPubMedGoogle Scholar
  14. Idris AH, Becker LB, Ornato JP, Hedges JR, Bircher NG, Chandra NC, Cummins RO, Dick W, Ebmeyer U, Halperin HR, Hazinski MF, Kerber RE, Kern KB, Safar P, Steen PA, Swindle MM, Tsitlik JE, von Planta I, von Planta M, Wears RL, Weil MH (1996) Utstein-style guidelines for uniform reporting of laboratory CPR research. A statement for healthcare professionals from a task force of the American Heart Association, the American College of Emergency Physicians, the American College of Cardiology, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Institute of Critical Care Medicine, the Safar Center for Resuscitation Research, and the Society for Academic Emergency Medicine. Writing Group. Circulation 94: 2324–2336Google Scholar
  15. Johnston, AJ, Gupta, AK 2002Advanced monitoring in the neurology intensive care unit: microdialysisCurr Opin Crit Care8121127CrossRefPubMedGoogle Scholar
  16. Klaus, S, Heringlake, M, Bahlmann, L 2004Bench-to-bedside review: microdialysis in intensive care medicineCrit Care8363368CrossRefPubMedGoogle Scholar
  17. Luchette, FA, Jenkins, WA, Friend, LA, Su, C, Fischer, JE, James, JH 2002Hypoxia is not the sole cause of lactate production during shockJ Trauma52415419CrossRefPubMedGoogle Scholar
  18. Magnoni, S, Ghisoni, L, Locatelli, M, Caimi, M, Colombo, A, Valeriani, V, Stocchetti, N 2003Lack of improvement in cerebral metabolism after hyperoxia in severe head injury: a microdialysis studyJ Neurosurg98952958CrossRefPubMedGoogle Scholar
  19. Menzel, M, Rieger, A, Roth, S, Soukup, J, Peuse, C, Hennig, C, Molnar, P, Furka, I, Radke, J 1998Simultaneous continuous measurement of pO2, pCO2, pH and temperature in brain tissue and sagittal sinus in a porcine modelActa Neurochir Suppl71183185PubMedGoogle Scholar
  20. Mussack, T, Biberthaler, P, Kanz, KG, Wiedemann, E, Gippner-Steppert, C, Mutschler, W, Jochum, M 2002Serum S-100B and interleukin-8 as predictive markers for comparative neurologic outcome analysis of patients after cardiac arrest and severe traumatic brain injuryCrit Care Med3026692674CrossRefPubMedGoogle Scholar
  21. Pelinka, LE, Bahrami, S, Szalay, L, Umar, F, Redl, H 2003Haemorrhagic shock induces an S 100 B increase associated with shock severityShock19422426CrossRefPubMedGoogle Scholar
  22. Pennings, F, Bouma, G, Ince, C 2002

    The assessment of determinants of cerebral oxygenation and microcirculation

    Pinsky, M eds. Cerebral blood flow mechanisms of ischemia, diagnosis, and therapySpringerNew York149164
    Google Scholar
  23. Persson, L, Valtysson, J, Enblad, P, Warme, PE, Cesarini, K, Lewen, A, Hillered, L 1996Neurochemical monitoring using intracerebral microdialysis in patients with subarachnoid haemorrhageJ Neurosurg84606616CrossRefPubMedGoogle Scholar
  24. Prough, DS, Johnson, JC, Stullken, EH, Stump, DA, Poole, GV,Jr, Howard, G 1985Effects on cerebral haemodynamics of resuscitation from endotoxic shock with hypertonic saline versus lactated Ringer’s solutionCrit Care Med1310401044PubMedCrossRefGoogle Scholar
  25. Rossi, S, Colombo, A, Magnoni, S, Roncati, EZ, Conte, V, Stocchetti, N 2002Cerebral veno-arterial pCO2 difference as an estimator of uncompensated cerebral hypoperfusionActa Neurochir Suppl81201204PubMedGoogle Scholar
  26. Sarrafzadeh, AS, Haux, D, Ludemann, L, Amthauer, H, Plotkin, M, Kuchler, I, Unterberg, AW 2004Cerebral ischaemia in aneurysmal subarachnoid haemorrhage: a correlative microdialysis-PET studyStroke35638643CrossRefPubMedGoogle Scholar
  27. Stahl, N, Mellergard, P, Hallstrom, A, Ungerstedt, U, Nordstrom, CH 2001Intracerebral microdialysis and bedside biochemical analysis in patients with fatal traumatic brain lesionsActa Anaesthesiol Scand45977985CrossRefPubMedGoogle Scholar
  28. Ungerstedt, U, Rostami, E 2004Microdialysis in neurointensive careCurr Pharm Des1021452152CrossRefPubMedGoogle Scholar
  29. Wenzel, V, Padosch, SA, Voelckel, WG, Idris, AH, Krismer, AC, Bettschart-Wolfensberger, R, Lindner, KH 2000Survey of effects of anaesthesia protocols on haemodynamic variables in porcine cardiopulmonary resuscitation laboratory models before induction of cardiac arrestComp Med50644648PubMedGoogle Scholar
  30. Yamauchi, Y, Kato, H, Kogure, K 1990Brain damage in a new haemorrhagic shock model in the rat using long-term recoveryJ Cereb Blood Flow Metab10207212PubMedGoogle Scholar
  31. Young, L, Ahmad, H 1999Trauma in the elderly: a new epidemic?Aust N Z J Surg69584586CrossRefPubMedGoogle Scholar
  32. Yu, ZY, Ono, S, Spatz, M, McCarron, RM 2002Effect of haemorrhagic shock on apoptosis and energy-dependent efflux system in the brainNeurochem Res2716251632CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • P. Meybohm
    • 1
  • E. Cavus
    • 1
  • B. Bein
    • 1
  • M. Steinfath
    • 1
  • B. Weber
    • 1
  • J. Scholz
    • 1
  • V. Doerges
    • 1
  1. 1.Department of Anaesthesiology and Intensive Care MedicineUniversity Hospital Schleswig-HolsteinCampus KielGermany

Personalised recommendations