Intracerebral hypoglycemia and its clinical relevance as a prognostic indicator in severe traumatic brain injury: A cerebral microdialysis study from India

Gupta, Deepak; Singla, Raghav; Kale, Shashank S.; Sharma, Bhawani S.

doi:10.4103/0028-3886.177617

Cited by 8 publications

(13 citation statements)

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“…In the studies by Gupta et al, levels of glutamate were significantly higher in the bad outcome group than the good outcome group: 40.31 µmol/L (SD 67.24) versus 21.68 µmol/L (SD 38.31), p < 0.01. [24][25][26] Recovering trends of glutamate values were seen in the good outcome group over a period of 5 days, consistent with previous studies. 38 This confirms that glutamate could be a useful prognostic marker in TBI.…”

Section: Glutamatesupporting

confidence: 89%

“…Gupta et al noted that the unfavorable outcome group showed significantly higher episodes of both mitochondrial dysfunction and ischemia than the favorable GOS group: 65.9% versus 55.9% (p < 0.0001); 13.9% versus 7.24% (p < 0.001), respectively. 25,26 These changes were more pronounced with pericontusional catheter placement. The authors compared the results for the time spent in each category, post-resuscitation GCS and age to the GOS score at last follow-up.…”

Section: Mitochondrial Dysfunction and Ischemiamentioning

confidence: 97%

“…Gupta et al 25,26 studied a cohort of 41 adult patients with severe TBI undergoing DC. Twenty-six (63.4%) patients had a favorable outcome (GOS score 4 or 5) and 15 patients (36.6%) had an unfavorable outcome (GOS scores 1-3) at 6 months' follow-up.…”

Section: Cerebral Microdialysis Usefulness In Neuromonitoring After Dmentioning

confidence: 99%

“…Similarly, the good outcome group showed rising microdialysis glucose to blood glucose ratios. This indicates a recovering metabolic state in the brain tissue that may indicate a good outcome 25,26 (►Fig. 7).…”

Section: Glucosementioning

confidence: 99%

“…An inverse correlation was also seen in the unfavorable outcome group (p < 0.01). 25,26 Nikaina et al previously showed that CPP and LPR have significant effects on the long-term outcome prognosis after a spontaneous cerebral hematoma. 32 They proposed a cutoff CPP of 75 mm Hg and LPR 36.…”

Section: Glucosementioning

confidence: 99%

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Cerebral Microdialysis: Going Deep into Brain Biochemistry for a Better Understanding of Pathomechanisms of Acute Brain Injury

Gupta

Mazzeo

2017

IJNS

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Patients with traumatic brain injury (TBI) have variable outcomes subject to intracranial hypertension, ischemia, hypotension, and various biochemical alterations. Multimodality neurointensive monitoring is standard of care for decision making in all severe TBI cases at present in most neurotrauma units. Neuromonitoring tools, such as cerebral microdialysis, may contribute to understanding the pathomechanisms of acute brain injury, provide an early warning of secondary cerebral deterioration (therapeutic window of opportunity), and help in selecting the patients most suitable to benefit from this very invasive surgical rescue therapy. Cerebral microdialysis can be used as a measure of the effect of decompressive craniectomy on neurochemistry derangement and brain energy crisis jeopardizing the injured brain. Present review discusses the cerebral microdialysis, its usefulness, and role in prognostication of severe TBIs, especially in patients post-decompressive craniectomy. The authors also discuss the current consensus guidelines on usage of cerebral microdialysis in TBI patients.

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Section: Glutamatesupporting

confidence: 89%

Section: Mitochondrial Dysfunction and Ischemiamentioning

confidence: 97%

Section: Cerebral Microdialysis Usefulness In Neuromonitoring After Dmentioning

confidence: 99%

Section: Glucosementioning

confidence: 99%

Section: Glucosementioning

confidence: 99%

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Cerebral Microdialysis: Going Deep into Brain Biochemistry for a Better Understanding of Pathomechanisms of Acute Brain Injury

Gupta

Mazzeo

2017

IJNS

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

et al. 2017

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ObjectiveTo perform a systematic review on commonly measured cerebral microdialysis (CMD) analytes and their association to: (A) patient functional outcome, (B) neurophysiologic measures, and (C) tissue outcome; after moderate/severe TBI. The aim was to provide a foundation for next-generation CMD studies and build on existing pragmatic expert guidelines for CMD.MethodsWe searched MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to October 2016). Strength of evidence was adjudicated using GRADE.Results(A) Functional Outcome: 55 articles were included, assessing outcome as mortality or Glasgow Outcome Scale (GOS) at 3–6 months post-injury. Overall, there is GRADE C evidence to support an association between CMD glucose, glutamate, glycerol, lactate, and LPR to patient outcome at 3–6 months. (B) Neurophysiologic Measures: 59 articles were included. Overall, there currently exists GRADE C level of evidence supporting an association between elevated CMD measured mean LPR, glutamate and glycerol with elevated ICP and/or decreased CPP. In addition, there currently exists GRADE C evidence to support an association between elevated mean lactate:pyruvate ratio (LPR) and low PbtO2. Remaining CMD measures and physiologic outcomes displayed GRADE D or no evidence to support a relationship. (C) Tissue Outcome: four studies were included. Given the conflicting literature, the only conclusion that can be drawn is acute/subacute phase elevation of CMD measured LPR is associated with frontal lobe atrophy at 6 months.ConclusionsThis systematic review replicates previously documented relationships between CMD and various outcome, which have driven clinical application of the technique. Evidence assessments do not address the application of CMD for exploring pathophysiology or titrating therapy in individual patients, and do not account for the modulatory effect of therapy on outcome, triggered at different CMD thresholds in individual centers. Our findings support clinical application of CMD and refinement of existing guidelines.Electronic supplementary materialThe online version of this article (10.1007/s00701-017-3338-2) contains supplementary material, which is available to authorized users.

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Early Cranioplasty Benefits Patients with Obvious Bilateral Frontotemporal Bone Window Collapse After Decompressive Craniectomy

Zhu

et al. 2018

World Neurosurgery

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Intracerebral hypoglycemia and its clinical relevance as a prognostic indicator in severe traumatic brain injury: A cerebral microdialysis study from India

Cited by 8 publications

References 0 publications

Cerebral Microdialysis: Going Deep into Brain Biochemistry for a Better Understanding of Pathomechanisms of Acute Brain Injury

Cerebral Microdialysis: Going Deep into Brain Biochemistry for a Better Understanding of Pathomechanisms of Acute Brain Injury

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

Early Cranioplasty Benefits Patients with Obvious Bilateral Frontotemporal Bone Window Collapse After Decompressive Craniectomy

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