Cerebral Microdialysis-Based Interventions Targeting Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage
| العنوان: | Cerebral Microdialysis-Based Interventions Targeting Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage |
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| المؤلفون: | Jakob Winberg, Isabella Holm, David Cederberg, Malin Rundgren, Erik Kronvall, Niklas Marklund |
| المصدر: | Neurocritical Care. 37:255-266 |
| بيانات النشر: | Springer Science and Business Media LLC, 2022. |
| سنة النشر: | 2022 |
| مصطلحات موضوعية: | Microdialysis, Humans, Vasospasm, Intracranial, Cerebral Infarction, Neurology (clinical), Subarachnoid Hemorrhage, Critical Care and Intensive Care Medicine, Brain Ischemia |
| الوصف: | Background Delayed cerebral ischemia (DCI), a complication of subarachnoid hemorrhage (SAH), is linked to cerebral vasospasm and associated with poor long-term outcome. We implemented a structured cerebral microdialysis (CMD) based protocol using the lactate/pyruvate ratio (LPR) as an indicator of the cerebral energy metabolic status in the neurocritical care decision making, using an LPR ≥ 30 as a cutoff suggesting an energy metabolic disturbance. We hypothesized that CMD monitoring could contribute to active, protocol-driven therapeutic interventions that may lead to the improved management of patients with SAH. Methods Between 2018 and 2020, 49 invasively monitored patients with SAH, median Glasgow Coma Scale 11 (range 3–15), and World Federation of Neurosurgical Societies scale 4 (range 1–5) on admission receiving CMD were included. We defined a major CMD event as an LPR ≥ 40 for ≥ 2 h and a minor CMD event as an LPR ≥ 30 for ≥ 2 h. Results We analyzed 7,223 CMD samples over a median of 6 days (5–8). Eight patients had no CMD events. In 41 patients, 113 minor events were recorded, and in 23 patients 42 major events were recorded. Our local protocols were adhered to in 40 major (95%) and 98 minor events (87%), with an active intervention in 32 (76%) and 71 (63%), respectively. Normalization of energy metabolic status (defined as four consecutive samples with LPR Conclusions Active interventions were initiated in a majority of LPR events based on CMD monitoring. A low DCI incidence was observed, which may be associated with the active interventions. The potential aid of CMD in the clinical decision-making targeting DCI needs confirmation in additional SAH studies. |
| تدمد: | 1556-0961 1541-6933 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::259dc28ef35d6aeda969539fbbf94a3bTest https://doi.org/10.1007/s12028-022-01492-5Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....259dc28ef35d6aeda969539fbbf94a3b |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15560961 15416933 |
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