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Is There Any Association Between Cerebral Vasoconstriction/Vasodilatation and Microdialysis Lactate to Pyruvate Ratio Increase?

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Abstract

Background

Although abnormally high Lactate/Pyruvate ratio (LPR) could indicate cerebral ischemia for brain injury patients, there is a debate on what is primary factor responsible for LPR increase.

Methods

A data analysis experiment is taken to test whether any association between cerebral vasodilatation/vasoconstriction and LPR increase exists. We studied 4,316 microdialysis data samples collected in an average interval of 1.3 h from 30 severe traumatic brain injury (TBI) patients. The LPR increase episodes were automatically identified using a moving time-window of 5 samples. A novel pulse morphological template matching (PMTM) algorithm was applied to the intracranial pressure (ICP) data of the corresponding patients to assess the occurrence of cerebral vasodilatation and vasoconstriction during the identified LPR increase episodes. Several analyses were performed to evaluate the association between cerebral vasoconstriction/vasodilatation and LPR increase.

Results

Results revealed that although more than half of the LPR increase episodes are not associated with any detected cerebral vasoconstriction/vasodilatation, when a vaso–change happens in association of LPR increase, it is more likely that this vaso–change is in the form of vasoconstriction rather than vasodilatation. Also for few subjects with dominant number of vasoconstriction episodes, a causality relationship between vasoconstriction and LPR increase were observed (vasoconstriction precedes LPR increase).

Conclusions

Using continuous intracranial pressure monitoring and our pulse morphological template matching (PMTM) algorithm could be potentially helpful in teasing out whether culprit cerebral vascular changes precede metabolic crisis for traumatic brain injury patients and hence guiding the management of this condition.

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Acknowledgments

The present work is partially supported by NS066008, NS076738, and UC Brain Injury Research Center (BIRC).

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Authors and Affiliations

  1. Department of Computer Engineering and Computer Science, California State University, Long Beach, CA, USA

    Shadnaz Asgari

  2. Neural Systems and Dynamics Laboratory, Department of Neurosurgery David Geffen School of Medicine, University of California, 18-265 Semel, 10833 Le Conte Avenue, Box 703919, Los Angeles, CA, 90095, USA

    Paul Vespa & Xiao Hu

  3. Neurocritical Care Program, Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA, USA

    Paul Vespa

  4. Biomedical Engineering Graduate Program, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, CA, USA

    Xiao Hu

Authors
  1. Shadnaz Asgari
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  2. Paul Vespa
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  3. Xiao Hu
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Correspondence to Xiao Hu.

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Asgari, S., Vespa, P. & Hu, X. Is There Any Association Between Cerebral Vasoconstriction/Vasodilatation and Microdialysis Lactate to Pyruvate Ratio Increase?. Neurocrit Care 19, 56–64 (2013). https://doi.org/10.1007/s12028-013-9821-6

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  • DOI: https://doi.org/10.1007/s12028-013-9821-6

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