A Prospective Observational Feasibility Study of Jugular Bulb Microdialysis in Subarachnoid Hemorrhage

Forsse, Axel; Nielsen, Troels Halfeld; Mölström, Simon; Hjelmborg, Jacob; Stokbro, Kasper; Nygaard, Kevin Hebøll; Yılmaz, Sibel Tanrıverdi; Nordström, Carl‐Henrik; Poulsen, Frantz Rom

doi:10.1007/s12028-019-00888-0

Cited by 6 publications

(6 citation statements)

References 47 publications

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“…Contrasting to previous studies utilizing JBM cardiac arrest causes complete ischemia and compromised energy metabolism in all body tissues 13,16 . To document that the biochemical variables measured in cerebral venous blood after ROSC reflected their intracerebral levels, MD catheters were placed in a peripheral artery for systemic reference, as well as in the jugular bulb.…”

Section: Discussionmentioning

confidence: 59%

“…Further, a strong correlation between intracerebral MD lactate and JBM lactate measurements, was described in patients suffering from aneurismal subarachnoid hemorrhage 16 . However, the measured levels of the variables do not represent their true interstitial concentrations: transport limitation across the blood-brain barrier (BBB), relative recovery of the microdialysis membrane and estimated imprecision (approximately 3-7%) of the analytical techniques all contribute to this fact 23 .…”

Section: Discussionmentioning

confidence: 89%

“…Neuromonitoring. JBM was initiated after ICU admission and continued for 96 h or until arousal utilizing identical techniques as in previous publications 13,16 . Intravenous MD catheters (CMA 67 IV, MDialysis AB, Stockholm, Sweden) were inserted in one jugular vein and one peripheral artery.…”

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confidence: 99%

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Bedside microdialysis for detection of early brain injury after out-of-hospital cardiac arrest

Mölström

Nielsen

Nordstrom

et al. 2021

Sci Rep

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Bedside detection and early treatment of lasting cerebral ischemia may improve outcome after out-of-hospital cardiac arrest (OHCA). This feasibility study explores the possibilities to use microdialysis (MD) for continuous monitoring of cerebral energy metabolism by analyzing the draining cerebral venous blood. Eighteen comatose patients were continuously monitored with jugular bulb and radial artery (reference) MD following resuscitation. Median time from cardiac arrest to MD was 300 min (IQR 230–390) with median monitoring time 60 h (IQR 40–81). The lactate/pyruvate ratio in cerebral venous blood was increased during the first 20 h after OHCA, and significant differences in time-averaged mean MD metabolites between jugular venous and artery measurements, were documented (p < 0.02). In patients with unfavorable outcome (72%), cerebral venous lactate and pyruvate levels remained elevated during the study period. In conclusion, the study indicates that jugular bulb microdialysis (JBM) is feasible and safe. Biochemical signs of lasting ischemia and mitochondrial dysfunction are frequent and associated with unfavorable outcome. The technique may be used in comatose OHCA patients to monitor biochemical variables reflecting ongoing brain damage and support individualized treatment early after resuscitation.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 89%

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Bedside microdialysis for detection of early brain injury after out-of-hospital cardiac arrest

Mölström

Nielsen

Nordstrom

et al. 2021

Sci Rep

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“…CMD has a probe-based mechanism that permits a discrete volume of the brain to be sampled for neurochemical investigation of biomarkers, neurotransmitters, metabolites, peptides, proteins, and chemotherapeutic drugs (e.g., temozolomide and methotrexate). CMD can be used to study brain tumors and is important for improving the cure of glioma [ 117 ], with respect to examining cerebral drainage in the jugular bulb [ 118 ] and diagnosing Japanese encephalitis virus [ 119 ].…”

Section: Sample Preparation Techniques In Bioanalyticsmentioning

confidence: 99%

Current developments of bioanalytical sample preparation techniques in pharmaceuticals

Ingle

Zeng

Jiang

et al. 2022

Journal of Pharmaceutical Analysis

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“…Twelve patients treated for aneurysmal SAH were included in the study and monitored for a mean period of 4.2 ± 2.6 days ( 96 ). Monitoring was initiated within 48 h of admission after all aneurysms had been secured by either endovascular coiling or open surgical clipping.…”

Section: Microdialysis Of Cerebral Venous Blood—clinicalmentioning

confidence: 99%

Bedside interpretation of cerebral energy metabolism utilizing microdialysis in neurosurgical and general intensive care

et al. 2022

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The microdialysis technique was initially developed for monitoring neurotransmitters in animals. In 1995 the technique was adopted to clinical use and bedside enzymatic analysis of glucose, pyruvate, lactate, glutamate and glycerol. Under clinical conditions microdialysis has also been used for studying cytokines, protein biomarkers, multiplex proteomic and metabolomic analyses as well as for pharmacokinetic studies and evaluation of blood-brain barrier function. This review focuses on the variables directly related to cerebral energy metabolism and the possibilities and limitations of microdialysis during routine neurosurgical and general intensive care. Our knowledge of cerebral energy metabolism is to a large extent based on animal experiments performed more than 40 years ago. However, the different biochemical information obtained from various techniques should be recognized. The basic animal studies analyzed brain tissue homogenates while the microdialysis technique reflects the variables in a narrow zone of interstitial fluid surrounding the probe. Besides the difference of the volume investigated, the levels of the biochemical variables differ in different compartments. During bedside microdialysis cerebral energy metabolism is primarily reflected in measured levels of glucose, lactate and pyruvate and the lactate to pyruvate (LP) ratio. The LP ratio reflects cytoplasmatic redox-state which increases instantaneously during insufficient aerobic energy metabolism. Cerebral ischemia is characterized by a marked increase in intracerebral LP ratio at simultaneous decreases in intracerebral levels of pyruvate and glucose. Mitochondrial dysfunction is characterized by a moderate increase in LP ratio at a very marked increase in cerebral lactate and normal or elevated levels of pyruvate and glucose. The patterns are of importance in particular for interpretations in transient cerebral ischemia. A new technique for evaluating global cerebral energy metabolism by microdialysis of the draining cerebral venous blood is discussed. In experimental studies it has been shown that pronounced global cerebral ischemia is reflected in venous cerebral blood. Jugular bulb microdialysis has been investigated in patients suffering from subarachnoid hemorrhage, during cardiopulmonary bypass and resuscitation after out of hospital cardiac arrest. Preliminary results indicate that the new technique may give valuable information of cerebral energy metabolism in clinical conditions when insertion of an intracerebral catheter is contraindicated.

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A Prospective Observational Feasibility Study of Jugular Bulb Microdialysis in Subarachnoid Hemorrhage

Cited by 6 publications

References 47 publications

Bedside microdialysis for detection of early brain injury after out-of-hospital cardiac arrest

Bedside microdialysis for detection of early brain injury after out-of-hospital cardiac arrest

Current developments of bioanalytical sample preparation techniques in pharmaceuticals

Bedside interpretation of cerebral energy metabolism utilizing microdialysis in neurosurgical and general intensive care

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