Intracerebral Microdialysis in Clinical Practice: Baseline Values for Chemical Markers during Wakefulness, Anesthesia, and Neurosurgery

Reinstrup, Peter; Ståhl, Nils; Mellergård, Pekka; Uski, Tore; Ungerstedt, Urban; Nordström, Carl‐Henrik

doi:10.1227/00006123-200009000-00035

Cited by 125 publications

(95 citation statements)

References 32 publications

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“…MD–L/P ratio was recently reported to be an independent positive predictor of poor outcome in a large cohort of TBI patients (29). Normal MD–L/P ratio values have been reported previously as approximately 15–20 (21, 22, 30, 31). Prior studies have used different L/P ratio threshold levels of cerebral ischemia ranging from 25 to 40 (17, 19, 32, 33).…”

Section: Discussionmentioning

confidence: 69%

“…The time periods with barbiturate induced coma were excluded from this study. Bold line on Y -axis (Figures 1–3) shows the tentative normal MD values based on Reinstrup et al (21) and Schulz et al (22). No correction for relative recovery (extraction efficiency) was made.…”

Section: Methodsmentioning

confidence: 95%

“…MD-glutamate basal concentration in humans ranges between 5 and 15 μmol/L (21, 22). A clinical B ti pO 2 TBI study identified MD-glutamate as the most sensitive and early marker of cerebral ischemia (15).…”

Section: Discussionmentioning

confidence: 99%

“…ICP (A) , CPP (B) , glutamate (C) , glycerol (D) , L/P ratio (E) , and glucose (F) at different B ti pO 2 levels in TBI patients with focal injury and probe (MD and NV) placement on the contralateral side from the injury (non-injured hemisphere). Bold line on Y -axis shows tentative normal MD values based on Reinstrup et al (21) and Schulz et al (22). All values are expressed as mean ± SD.…”

Section: Methodsmentioning

confidence: 99%

“…TBI patients with diffuse axonal injury and probe (MD and NV) placements in the right frontal hemisphere. Bold line on Y -axis shows tentative normal MD values based on Reinstrup et al (21) and Schulz et al (22). All values are expressed as mean ± SD.…”

Section: Methodsmentioning

confidence: 99%

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Brain Tissue Oxygenation and Cerebral Metabolic Patterns in Focal and Diffuse Traumatic Brain Injury

et al. 2014

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Introduction: Neurointensive care of traumatic brain injury (TBI) patients is currently based on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) targeted protocols. There are reasons to believe that knowledge of brain tissue oxygenation (BtipO2) would add information with the potential of improving patient outcome. The aim of this study was to examine BtipO2 and cerebral metabolism using the Neurovent-PTO probe and cerebral microdialysis (MD) in TBI patients.Methods: Twenty-three severe TBI patients with monitoring of physiological parameters, ICP, CPP, BtipO2, and MD for biomarkers of energy metabolism (glucose, lactate, and pyruvate) and cellular distress (glutamate, glycerol) were included. Patients were grouped according to injury type (focal/diffuse) and placement of the Neurovent-PTO probe and MD catheter (injured/non-injured hemisphere).Results: We observed different patterns in BtipO2 and MD biomarkers in diffuse and focal injury where placement of the probe also influenced the results (ipsilateral/contralateral). In all groups, despite fairly normal levels of ICP and CPP, increased MD levels of glutamate, glycerol, or the L/P ratio were observed at BtipO2 <5 mmHg, indicating increased vulnerability of the brain at this level.Conclusion: Monitoring of BtipO2 adds important information in addition to traditional ICP and CPP surveillance. Because of the different metabolic responses to very low BtipO2 in the individual patient groups we submit that brain tissue oximetry is a complementary tool rather than an alternative to MD monitoring.

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Section: Discussionmentioning

confidence: 69%

Section: Methodsmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Brain Tissue Oxygenation and Cerebral Metabolic Patterns in Focal and Diffuse Traumatic Brain Injury

et al. 2014

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Extracellular metabolites in the cortex and hippocampus of epileptic patients

Çavuş

Kasoff

Cassaday

et al. 2005

Annals of Neurology

261

228

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Interictal brain energy metabolism and glutamate-glutamine cycling are impaired in epilepsy and may contribute to seizure generation. We used the zero-flow microdialysis method to measure the extracellular levels of glutamate, glutamine, and the major energy substrates glucose and lactate in the epileptogenic and the nonepileptogenic cortex and hippocampus of 38 awake epileptic patients during the interictal period. Depth electrodes attached to microdialysis probes were used to identify the epileptogenic and the nonepileptogenic sites. The epileptogenic hippocampus had surprisingly high basal glutamate levels, low glutamine/glutamate ratio, high lactate levels, and indication for poor glucose utilization. The epileptogenic cortex had only marginally increased glutamate levels. We propose that interictal energetic deficiency in the epileptogenic hippocampus could contribute to impaired glutamate reuptake and glutamate-glutamine cycling, resulting in persistently increased extracellular glutamate, glial and neuronal toxicity, increased lactate production together with poor lactate and glucose utilization, and ultimately worsening energy metabolism. Our data suggest that a different neurometabolic process underlies the neocortical epilepsies.

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Biomedical applications of capillary electrophoresis with laser‐induced fluorescence detection

Páez

Hernández

2001

Biopharm & Drug Disp

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Capillary electrophoresis (CE) is a high-efficiency analytical technique that has had a great impact as a tool in biomedical research, clinical and forensic practice in the last ten years. Only in one of the applications, the DNA analysis, it has had an explosive exponential growth in the last few years. This impact is expressed in an enormous amount of CE articles and many reviews. The CE advantages with respect to other analytical techniques: the required very small sample volume, rapid analysis, great resolution power and low costs, have made this technique ideal for the analysis of a numerous endogenous and exogenous substances present in biological fluids. The different modes of CE have been coupled to different detection techniques such as UV-absorbance, electrochemical, mass spectrometry and laser-induced fluorescence detection (LIFD) to detect different nature and molecular size separated analytes. This review focuses mostly on the applications of CE-LIFD, to measure drugs and endogenous neuroactive substances such as amino acids and monoamines, especially in microdialysis samples from experimental animals and humans. CE-LIFD trends are discussed: automated faster analysis with capillary array systems, resolution power improvement, higher detection sensitivity, and CE systems miniaturization for extremely small sample volume, in order to make CE easier and affordable to the lab bench or the clinical bed.

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Intracerebral Microdialysis in Clinical Practice: Baseline Values for Chemical Markers during Wakefulness, Anesthesia, and Neurosurgery

Cited by 125 publications

References 32 publications

Brain Tissue Oxygenation and Cerebral Metabolic Patterns in Focal and Diffuse Traumatic Brain Injury

Brain Tissue Oxygenation and Cerebral Metabolic Patterns in Focal and Diffuse Traumatic Brain Injury

Extracellular metabolites in the cortex and hippocampus of epileptic patients

Biomedical applications of capillary electrophoresis with laser‐induced fluorescence detection

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