Summary
We evaluated bedside cerebral on-line microdialysis for early detection of cerebral hypoxia in patients with traumatic brain injury. 24 severely head injured patients (Glasgow Coma Score ≤ 8) were studied. Patients underwent continuous brain tissue PO2 (PtiO2) monitoring using the LICOX (GMS mbH, Germany) microcatheter device. The catheter was placed into the non-lesioned frontal white matter within 32.2 (7–48) hrs post injury. The microdialysis catheter (CMA 100, Sweden) was placed close to the PtiO2 probe via a 2- or 3-way skull screw, connected to a pump and perfused with Ringer solution (0.3 μl/min). The microdialysis samples were collected hourly and analyzed at the bedside for glucose, lactate, lactate-pyr-uvate-ratio and glutamate (CMA 600, Sweden). We identified 252 episodes of impending hypoxia (PtiO2 < 15 mmHg; 11810 minutes) and 38 episodes of cerebral hypoxia (PtiO2 < 10 mm Hg; 1996 minutes). Before cerebral hypoxia, glucose decreased significantly. Glutamate was unchanged when no hypoxia or impending hypoxia occurred but increased 3–4fold before a hypoxic episode appeared. We conclude that early metabolic detection of cerebral hypoxia before a critical decrease in brain tissue PtiO2 is seen and possibly allows earlier changes in treatment (e.g. reduction of hyperventilation therapy).
Supported by Deutsche Forschungsgemeinschaft Un-56/7.
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© 2002 Springer-Verlag
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Sarrafzadeh, A.S., Sakowitz, O.W., Callsen, TA., Lanksch, W.R., Unterberg, A.W. (2002). Detection of Secondary Insults by Brain Tissue pO2 and Bedside Microdialysis in Severe Head Injury. In: Czosnyka, M., Pickard, J.D., Kirkpatrick, P.J., Smielewski, P., Hutchinson, P. (eds) Intracranial Pressure and Brain Biochemical Monitoring. Acta Neurochirurgica Supplements, vol 81. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6738-0_81
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DOI: https://doi.org/10.1007/978-3-7091-6738-0_81
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