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The neurological wake-up test does not alter cerebral energy metabolism and oxygenation in patients with severe traumatic brain injury

Skoglund, Karin; Hillered, Lars; Purins, Karlis; Tsitsopoulos, Parmenion P; Flygt, Johanna; Engquist, Henrik; Lewén, Anders; Enblad, Per and Marklund, Niklas LU (2014) In Neurocritical Care 20(3). p.26-413
Abstract

BACKGROUND: The neurological wake-up test (NWT) is used to monitor the level of consciousness in patients with traumatic brain injury (TBI). However, it requires interruption of sedation and may elicit a stress response. We evaluated the effects of the NWT using cerebral microdialysis (MD), brain tissue oxygenation (PbtiO2), jugular venous oxygen saturation (SjvO2), and/or arterial-venous difference (AVD) for glucose, lactate, and oxygen in patients with severe TBI.

METHODS: Seventeen intubated TBI patients (age 16-74 years) were sedated using continuous propofol infusion. All patients received intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring in addition to MD, PbtiO2 and/or SjvO2. Up to 10 days... (More)

BACKGROUND: The neurological wake-up test (NWT) is used to monitor the level of consciousness in patients with traumatic brain injury (TBI). However, it requires interruption of sedation and may elicit a stress response. We evaluated the effects of the NWT using cerebral microdialysis (MD), brain tissue oxygenation (PbtiO2), jugular venous oxygen saturation (SjvO2), and/or arterial-venous difference (AVD) for glucose, lactate, and oxygen in patients with severe TBI.

METHODS: Seventeen intubated TBI patients (age 16-74 years) were sedated using continuous propofol infusion. All patients received intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring in addition to MD, PbtiO2 and/or SjvO2. Up to 10 days post-injury, ICP, CPP, PbtiO2 (51 NWTs), MD (49 NWTs), and/or SjvO2 (18 NWTs) levels during propofol sedation (baseline) and NWT were compared. MD was evaluated at a flow rate of 1.0 μL/min (28 NWTs) or the routine 0.3 μL/min rate (21 NWTs).

RESULTS: The NWT increased ICP and CPP levels (p < 0.05). Compared to baseline, interstitial levels of glucose, lactate, pyruvate, glutamate, glycerol, and the lactate/pyruvate ratio were unaltered by the NWT. Pathological SjvO2 (<50 % or >71 %; n = 2 NWTs) and PbtiO2 (<10 mmHg; n = 3 NWTs) values were rare at baseline and did not change following NWT. Finally, the NWT did not alter the AVD of glucose, lactate, or oxygen.

CONCLUSIONS: The NWT-induced stress response resulted in increased ICP and CPP levels although it did not negatively alter focal neurochemistry or cerebral oxygenation in TBI patients.

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Contribution to journal
publication status
published
keywords
Adolescent, Adult, Aged, Arousal, Brain, Brain Injuries, Consciousness Disorders, Critical Care, Energy Metabolism, Female, Humans, Hypnotics and Sedatives, Intracranial Pressure, Jugular Veins, Male, Microdialysis, Middle Aged, Neurologic Examination, Oxygen, Stress, Physiological, Trauma Severity Indices, Young Adult, Journal Article, Research Support, Non-U.S. Gov't
in
Neurocritical Care
volume
20
issue
3
pages
14 pages
publisher
Humana Press
external identifiers
  • scopus:84902384968
ISSN
1541-6933
DOI
10.1007/s12028-013-9876-4
language
English
LU publication?
no
id
01fb11c5-588a-4ecc-8c4e-9217a468b5df
date added to LUP
2016-12-08 12:21:25
date last changed
2017-11-05 05:10:50
@article{01fb11c5-588a-4ecc-8c4e-9217a468b5df,
  abstract     = {<p>BACKGROUND: The neurological wake-up test (NWT) is used to monitor the level of consciousness in patients with traumatic brain injury (TBI). However, it requires interruption of sedation and may elicit a stress response. We evaluated the effects of the NWT using cerebral microdialysis (MD), brain tissue oxygenation (PbtiO2), jugular venous oxygen saturation (SjvO2), and/or arterial-venous difference (AVD) for glucose, lactate, and oxygen in patients with severe TBI.</p><p>METHODS: Seventeen intubated TBI patients (age 16-74 years) were sedated using continuous propofol infusion. All patients received intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring in addition to MD, PbtiO2 and/or SjvO2. Up to 10 days post-injury, ICP, CPP, PbtiO2 (51 NWTs), MD (49 NWTs), and/or SjvO2 (18 NWTs) levels during propofol sedation (baseline) and NWT were compared. MD was evaluated at a flow rate of 1.0 μL/min (28 NWTs) or the routine 0.3 μL/min rate (21 NWTs).</p><p>RESULTS: The NWT increased ICP and CPP levels (p &lt; 0.05). Compared to baseline, interstitial levels of glucose, lactate, pyruvate, glutamate, glycerol, and the lactate/pyruvate ratio were unaltered by the NWT. Pathological SjvO2 (&lt;50 % or &gt;71 %; n = 2 NWTs) and PbtiO2 (&lt;10 mmHg; n = 3 NWTs) values were rare at baseline and did not change following NWT. Finally, the NWT did not alter the AVD of glucose, lactate, or oxygen.</p><p>CONCLUSIONS: The NWT-induced stress response resulted in increased ICP and CPP levels although it did not negatively alter focal neurochemistry or cerebral oxygenation in TBI patients.</p>},
  author       = {Skoglund, Karin and Hillered, Lars and Purins, Karlis and Tsitsopoulos, Parmenion P and Flygt, Johanna and Engquist, Henrik and Lewén, Anders and Enblad, Per and Marklund, Niklas},
  issn         = {1541-6933},
  keyword      = {Adolescent,Adult,Aged,Arousal,Brain,Brain Injuries,Consciousness Disorders,Critical Care,Energy Metabolism,Female,Humans,Hypnotics and Sedatives,Intracranial Pressure,Jugular Veins,Male,Microdialysis,Middle Aged,Neurologic Examination,Oxygen,Stress, Physiological,Trauma Severity Indices,Young Adult,Journal Article,Research Support, Non-U.S. Gov't},
  language     = {eng},
  number       = {3},
  pages        = {26--413},
  publisher    = {Humana Press},
  series       = {Neurocritical Care},
  title        = {The neurological wake-up test does not alter cerebral energy metabolism and oxygenation in patients with severe traumatic brain injury},
  url          = {http://dx.doi.org/10.1007/s12028-013-9876-4},
  volume       = {20},
  year         = {2014},
}