Elevated Intracranial Pressure, Low Cerebral Perfusion Pressure, and Impaired Brain Metabolism Correlate with Fatal Outcome After Severe Brain Injury

Abstract

High ICP, low CPP, an elevated mean LP ratio, and high glycerol concentrations in the acute phase predict fatal outcome 6 months after TBI. Further, high ICP, low CPP, and low PbtO2 correlate with impaired brain metabolism.

A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome

“…Of the 55 articles included in the review [ 2 , 3 , 6 , 8 – 10 , 12 – 14 , 16 – 18 , 20 , 21 , 25 , 27 – 29 , 34 , 38 , 42 , 44 , 45 , 47 , 48 , 51 , 53 – 55 , 60 – 62 , 64 – 66 , 68 – 71 , 73 – 76 , 80 , 81 , 86 , 88 , 91 – 93 , 99 , 103 , 105 , 107 , 108 ], 33 were formal manuscript publications and 22 were meeting abstract publications. There were 26 prospective studies, with three randomized control trials (RCT), 22 observational studies, and one single-arm study.…”

“…Of the 59 articles included in this systematic review [ 1 , 3 – 5 , 7 , 10 – 13 , 15 , 17 , 18 , 21 , 25 , 26 , 28 , 34 , 39 , 40 , 44 , 47 , 48 , 51 , 52 , 56 – 58 , 60 – 63 , 68 – 72 , 74 – 76 , 78 , 79 , 81 – 84 , 86 , 87 , 89 , 91 , 93 – 101 , 105 , 109 ], 30 were prospective observational studies, four were prospective single-arm studies, one was a non-randomized controlled study, and 12 were retrospective case series. Twelve articles failed to provide enough information in order to determine the exact type of study conducted [ 3 , 15 , 28 , 47 , 68 , 76 , 79 , 82 , 84 , 86 , 89 , 109 ] and were classified as “unknown”.…”

“…The mean age varied across all studies, ranging from 8 years to 58.2 years. Twenty-three studies failed to disclose the age of the patients [ 3 , 10 , 12 , 15 , 17 , 21 , 28 , 34 , 47 , 58 , 68 , 72 , 74 , 76 , 83 , 84 , 86 , 89 , 91 , 93 , 94 , 96 , 109 ]. Only four studies reported the inclusion of a small number of pediatric patients (age under 16) [ 51 , 56 , 61 ], with only one study clearly displaying the number of pediatric patients [ 75 ].…”

“…Fourteen studies reported an association between CMD measured glycerol and patient outcome, measured as mortality and/or GOS at 3–6 months [ 8 , 10 , 17 , 20 , 28 , 34 , 42 , 45 , 51 , 54 , 69 , 70 , 93 , 105 ]. There was a documented statistically significant association between elevated mean CMD glycerol levels and increased mortality/poor outcome at 3–6 months [ 12 – 14 , 27 ].…”

Coefficient of energy balance, a new parameter for basic investigation of the cerebrospinal fluid

“…The model for calculating the KEB includes the amount of lactate produced in the CSF compartment. Its additional sources from the brain parenchyma or blood are part of the natural background, which is included in the overall concentration of lactate in the CSF [18,[30][31][32]. We assume a continuous dynamic equilibrium between the supply of glucose and the continuous production of lactate in the CSF compartment for basic CSF examination purposes.…”