The relationship between intracranial pressure and lactate/pyruvate ratio in patients with subarachnoid haemorrhage

Abstract

AIM: The aim of this study was to analyse the relationship between intracranial pressure (intracranial pressure monitoring) and lactate pyruvate ratio (cerebral microdialysis) in patients with ruptured intracranial aneurysms. METHODS: In a group of fi fteen patients, intracranial pressure and lactate/pyruvate ratios were measured and logged in hourly intervals. The relationship between these two variables was subsequently analysed in two ways. 1) Intracranial hypertension (ICP > 20 mmHg) in the presence of energy deprivation (L/P ratio > 30) was noted.2) The dynamics of L/P ratio changes in relation to immediate ICP and CPP values was analysed. RESULTS: Out of a total of 1873 monitored hours we were able to record lactate/pyruvate ratios higher than 30 in 832 hours (44 %). Of those 832 hours during which lactate/pyruvate ratios were higher than 30, ICP was higher than 20 in 193 hours (23 %). Out of 219 hours of monitoring, in which ICP was higher than 20, a simultaneously increased L/P ratio higher than 30 was recorded in 193 hours (88 %). L/P ratio values above 30 were associated with decreased CPP values (p = 0.04), but not with increased ICP values (p = 0.79). CONCLUSION: Intracranial hypertension coincides with energetic imbalance in approximately one quarter of cases. This points to the shortcomings of the most common form of neuromonitoring in SAH patients -ICP monitoring. This method may not be reliable enough in detecting hypoxic damage, which is the major cause of morbidity and mortality in SAH patients (Fig. 5, Ref. 11). Text in PDF www.elis.sk. KEY WORDS: subarachnoid haemorrhage, intracranial pressure, brain microdialysis, lactate/pyruvate ratio.

Using Cerebral Metabolites to Guide Precision Medicine for Subarachnoid Hemorrhage: Lactate and Pyruvate

“…Manipulation of ICP, such as opening the EVD to reduce pressure in patients with high ICP, resulted in a surge of pyruvate [61]. Similarly in other studies, increased ICP (≥ 20 mmHg) on days 1 to 7 after SAH was positively correlated with an elevated ISF LPR (> 25) [62] and decreased cerebral perfusion [50]. The derangement of metabolites occurred prior to the increase in ICP and lowered cerebral perfusion, with over 80% of patients with intracranial hypertension presenting with deranged metabolism (an LPR of greater than 25) prior to the first rise in ICP.…”

Feasibility of noninvasive near-infrared spectroscopy monitoring in predicting the prognosis of spontaneous intracerebral hemorrhage

“…In recent years, a growing body of clinical evidence has demonstrated that multimodal neural monitoring, including parameters such as ICP, BT, and cerebral oxygen metabolism, plays a crucial role in mitigating the risks of secondary brain injury in individual patients and can serve as valuable predictors for assessing the prognosis after SICH (9,10). Multimodal monitoring is an important reference index for the diagnosis and treatment of clinical neurosurgical diseases, offering valuable insights for the identification and determination of intracranial conditions.…”

Serum lactate monitoring may help to predict neurological function impairment caused by acute metabolism crisis

“…The result found that the lactate/ pyruvate concentration the first 4 days after admission was correlated with Glasgow-Pittsburgh cerebral performance category 30 days after cardiac arrest, whereas the glucose was correlated with the outcomes until 3.5 days after admission 15 . A study suggested that a lactate/ pyruvate higher than 30 was correlated with low cerebral perfusion pressure (CPP), while it was not correlated with increased intra-cranial pressure (ICP) by investigating the data of 1873 cases 16 .…”