Summary
We evaluated the performance of continuous intracerebral microdialysis to indicate the autoregulatory reserve in 36 severely headinjured patients. All patients received standard treatment with intracranial pressure (ICP) monitoring. A microdialysis probe was placed in the frontal cortex anterior to the ICP catheter. Perfusate was collected frequently and extracellular concentration of glutamate was measured online using enzymatic method. Autoregulatory index was calculated by comparing glutamate concentration with CPP using Pearson’s correlation. A correlation coefficient (r) < −0.5 is considered as loss of autoregulation, whereas r values approach 0 indicate preserved autoregulation. The change of autoregulatory status over time was correlated with outcome at 6 months.
Three patterns of autoregulatory profiles were identified. Patients with intact autoregulation had satisfactory outcome. Transient impairment of autoregulation may result in favorable outcome if patients responded to treatment. However, persistent loss of autoregulation was associated with poor outcome (P < 0.001).
The correlation between extracellular glutamate concentration (by microdialysis) and CPP is a useful index of autoregulation in head-injured patients. It predicts clinical outcome and may be used to guide therapy.
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References
Aaslid R, Lindegaard KF, Sorteberg W, Nornes H (1989) Cerebral autoregulation dynamics in humans. Stroke 20: 45–52
Chan MTV, Ng SCP, Lam JMK, Poon WS, Gin T (2005) Re-defining the ischemic threshold for jugular venous oxygen saturation — a microdialysis study in patients with severe head injury. Acta Neurochir [Suppl] (in press)
Czosnyka M, Smielewski P, Kirkpatrick P, Menon DK, Pickard JD (1996) Monitoring of cerebral autoregulation in head-injured patients. Stroke 27: 1829–1834
Enevoldsen EM, Jensen FT (1978) Autoregulation and CO2 responses of cerebral blood flow in patients with acute severe head injury. J Neurosurg 48: 689–703
Giller CA (1991) A bedside test for cerebral autoregulation using transcranial Doppler ultrasound. Acta Neurochir (Wien) 108: 7–14.
Hlatky R, Furuya Y, Valadka AB, Gonzalez J, Chacko A, Mizutani Y, Contant CF, Robertson CS (2002) Dynamic autoregulatory response after severe head injury. J Neurosurg 97: 1054–1061
Lam JMK, Hsiang JNK, Poon WS (1997) Monitoring of autoregulation using laser Doppler flowmetry in patients with head injury. J Neurosurg 86: 438–445
Lam JMK, Smielewski P, al-Rawi P, Griffiths P, Pickard JD, Kirkpatrick PJ (1997) Internal and external carotid contributions to near-infrared spectroscopy during carotid endarterectomy. Stroke 28: 906–911
Overgaard J, Tweed WA (1974) Cerebral circulation after head injury, 1: cerebral blood flow and its regulation after closed head injury with emphasis on clinical correlations. J Neurosurg 41: 531–541
Peerdeman SM, Girbes AR, Vandertop WP (2000) Cerebral microdialysis as a new tool for neurometabolic monitoring. Intensive Care Med 26: 662–669
Poon WS, Ng SC, Chan MT, Leung CH, Lam JM (2002) Neurochemical changes in ventilated head-injured patients with cerebral perfusion pressure treatment failure. Acta Neurochir [Suppl] 81: 335–338
Whittle IR, Glasby M, Lammie A, Bell H, Ungerstedt U (1998) Neuropathological findings after intracerebral implantation of microdialysis catheter. Neuro Report 9: 2821–2825
Siddiqui MM, Shuaib A (2001) Intracerebral microdialysis and its clinical application: a review. Methods 23: 83–94
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© 2005 Springer-Verlag
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Chan, M.T.V., Ng, S.C.P., Lam, J.M.K., Poon, W.S., Gin, T. (2005). Monitoring of autoregulation using intracerebral microdialysis in patients with severe head injury. In: Poon, W.S., et al. Intracranial Pressure and Brain Monitoring XII. Acta Neurochirurgica Supplementum, vol 95. Springer, Vienna. https://doi.org/10.1007/3-211-32318-X_24
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DOI: https://doi.org/10.1007/3-211-32318-X_24
Publisher Name: Springer, Vienna
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