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Relationship between intracranial hemodynamics and microdialysis markers of energy metabolism and glutamate-glutamine turnover in patients with subarachnoid hemorrhage. Clinical article

Samuelsson, Carolina LU ; Howells, Timothy ; Kumlien, Eva ; Enblad, Per ; Hillered, Lars and Ronne-Engström, Elisabeth (2009) In Journal of Neurosurgery 111(5). p.5-910
Abstract

OBJECT: The aim of this study was to explore the relationship between hemodynamics (intracranial and systemic) and brain tissue energy metabolism, and between hemodynamics and glutamate (Glt)-glutamine (Gln) cycle activity.

METHODS: Brain interstitial levels of lactate, pyruvate, Glt, and Gln were prospectively monitored in the neurointensive care unit for more than 3600 hours using intracerebral microdialysis in 33 patients with subarachnoid hemorrhage (SAH). Intracranial pressure (ICP), mean arterial blood pressure, and cerebral perfusion pressure (CPP) were recorded using a digitalized system.

RESULTS: Interstitial Gln and pyruvate correlated with CPP (r = 0.25 and 0.24, respectively). Intracranial pressure negatively... (More)

OBJECT: The aim of this study was to explore the relationship between hemodynamics (intracranial and systemic) and brain tissue energy metabolism, and between hemodynamics and glutamate (Glt)-glutamine (Gln) cycle activity.

METHODS: Brain interstitial levels of lactate, pyruvate, Glt, and Gln were prospectively monitored in the neurointensive care unit for more than 3600 hours using intracerebral microdialysis in 33 patients with subarachnoid hemorrhage (SAH). Intracranial pressure (ICP), mean arterial blood pressure, and cerebral perfusion pressure (CPP) were recorded using a digitalized system.

RESULTS: Interstitial Gln and pyruvate correlated with CPP (r = 0.25 and 0.24, respectively). Intracranial pressure negatively correlated with Gln (r = -0.29) and the Gln/Glt ratio (r = -0.40). Levels of Gln and pyruvate and the Gln/Glt ratio were higher and levels of Glt and lactate and the lactate/pyruvate ratio were lower during periods of decreased ICP (<or= 10 mm Hg) as compared with values in periods of elevated ICP (> 10 mm Hg). In 3 patients, a poor clinical condition was attributed to high ICP levels (range 15-25 mm Hg). When CSF drainage was increased and the ICP was lowered to 10 mm Hg, there was an instantaneous sharp increase in interstitial Glt and pyruvate in these 3 patients.

CONCLUSIONS: Increasing interstitial Gln and pyruvate levels appear to be favorable signs associated with improved CPP and low ICP. The authors suggest that this pattern indicates an energy metabolic situation allowing augmented astrocytic energy metabolism with accelerated Glt uptake and Gln synthesis. Moreover, their data raised the question of whether patients with SAH and moderately elevated ICP (15-20 mm Hg) would benefit from CSF drainage at lower pressure levels than what is usually indicated in current clinical protocols.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
Aged, Biomarkers, Blood Pressure/physiology, Cerebrovascular Circulation/physiology, Critical Care, Energy Metabolism/physiology, Female, Glutamic Acid/metabolism, Glutamine/metabolism, Hemodynamics/physiology, Humans, Intracranial Pressure/physiology, Lactic Acid/metabolism, Male, Microdialysis, Middle Aged, Prospective Studies, Pyruvic Acid/metabolism, Retrospective Studies, Subarachnoid Hemorrhage/metabolism
in
Journal of Neurosurgery
volume
111
issue
5
pages
6 pages
publisher
American Association of Neurosurgeons
external identifiers
  • scopus:70349774301
  • pmid:19425889
ISSN
0022-3085
DOI
10.3171/2008.8.JNS0889
language
English
LU publication?
no
id
f1c91f74-767b-442c-b241-381dde2dd418
date added to LUP
2019-06-05 16:04:52
date last changed
2020-06-10 06:09:09
@article{f1c91f74-767b-442c-b241-381dde2dd418,
  abstract     = {<p>OBJECT: The aim of this study was to explore the relationship between hemodynamics (intracranial and systemic) and brain tissue energy metabolism, and between hemodynamics and glutamate (Glt)-glutamine (Gln) cycle activity.</p><p>METHODS: Brain interstitial levels of lactate, pyruvate, Glt, and Gln were prospectively monitored in the neurointensive care unit for more than 3600 hours using intracerebral microdialysis in 33 patients with subarachnoid hemorrhage (SAH). Intracranial pressure (ICP), mean arterial blood pressure, and cerebral perfusion pressure (CPP) were recorded using a digitalized system.</p><p>RESULTS: Interstitial Gln and pyruvate correlated with CPP (r = 0.25 and 0.24, respectively). Intracranial pressure negatively correlated with Gln (r = -0.29) and the Gln/Glt ratio (r = -0.40). Levels of Gln and pyruvate and the Gln/Glt ratio were higher and levels of Glt and lactate and the lactate/pyruvate ratio were lower during periods of decreased ICP (&lt;or= 10 mm Hg) as compared with values in periods of elevated ICP (&gt; 10 mm Hg). In 3 patients, a poor clinical condition was attributed to high ICP levels (range 15-25 mm Hg). When CSF drainage was increased and the ICP was lowered to 10 mm Hg, there was an instantaneous sharp increase in interstitial Glt and pyruvate in these 3 patients.</p><p>CONCLUSIONS: Increasing interstitial Gln and pyruvate levels appear to be favorable signs associated with improved CPP and low ICP. The authors suggest that this pattern indicates an energy metabolic situation allowing augmented astrocytic energy metabolism with accelerated Glt uptake and Gln synthesis. Moreover, their data raised the question of whether patients with SAH and moderately elevated ICP (15-20 mm Hg) would benefit from CSF drainage at lower pressure levels than what is usually indicated in current clinical protocols.</p>},
  author       = {Samuelsson, Carolina and Howells, Timothy and Kumlien, Eva and Enblad, Per and Hillered, Lars and Ronne-Engström, Elisabeth},
  issn         = {0022-3085},
  language     = {eng},
  number       = {5},
  pages        = {5--910},
  publisher    = {American Association of Neurosurgeons},
  series       = {Journal of Neurosurgery},
  title        = {Relationship between intracranial hemodynamics and microdialysis markers of energy metabolism and glutamate-glutamine turnover in patients with subarachnoid hemorrhage. Clinical article},
  url          = {http://dx.doi.org/10.3171/2008.8.JNS0889},
  doi          = {10.3171/2008.8.JNS0889},
  volume       = {111},
  year         = {2009},
}