Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage.

Détails

ID Serval
serval:BIB_8EB270BD5187
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Bedside cerebral microdialysis monitoring of delayed cerebral hypoperfusion in comatose patients with poor grade aneurysmal subarachnoid haemorrhage.
Périodique
Journal of neurology, neurosurgery, and psychiatry
Auteur(s)
Patet C., Quintard H., Zerlauth J.B., Maibach T., Carteron L., Suys T., Bouzat P., Bervini D., Levivier M., Daniel R.T., Eckert P., Meuli R., Oddo M.
ISSN
1468-330X (Electronic)
ISSN-L
0022-3050
Statut éditorial
Publié
Date de publication
04/2017
Peer-reviewed
Oui
Volume
88
Numéro
4
Pages
332-338
Langue
anglais
Notes
Publication types: Journal Article ; Observational Study
Publication Status: ppublish
Résumé
Delayed cerebral ischaemia (DCI) is frequent after poor grade aneurysmal subarachnoid haemorrhage (SAH). Owing to the limited accuracy of clinical examination, DCI diagnosis is often based on multimodal monitoring. We examined the value of cerebral microdialysis (CMD) in this setting.
20 comatose SAH participants underwent CMD monitoring-for hourly sampling of cerebral extracellular lactate/pyruvate ratio (LPR) and glucose-and brain perfusion CT (PCT). Patients were categorised as DCI when PCT (8±3 days after SAH) showed cerebral hypoperfusion, defined as cerebral blood flow <32.5 mL/100 g/min with a mean transit time >5.7 s. Clinicians were blinded to CMD data; for the purpose of the study, only patients who developed cerebral hypoperfusion in anterior and/or middle cerebral arteries were analysed.
DCI (n=9/20 patients) was associated with higher CMD LPR (51±36 vs 31±10 in patients without DCI, p=0.0007) and lower CMD glucose (0.64±0.34 vs 1.22±1.05, p=0.0005). In patients with DCI, CMD changes over the 18 hours preceding PCT diagnosis revealed a pattern of CMD LPR increase (coefficient +2.96 (95% CI 0.13 to 5.79), p=0.04) with simultaneous CMD glucose decrease (coefficient -0.06 (95% CI -0.08 to -0.01), p=0.03, mixed-effects multilevel regression model). No significant CMD changes were noted in patients without DCI.
In comatose patients with SAH, delayed cerebral hypoperfusion correlates with a CMD pattern of lactate increase and simultaneous glucose decrease. CMD abnormalities became apparent in the hours preceding PCT, thereby suggesting that CMD monitoring may anticipate targeted therapeutic interventions.

Mots-clé
Adult, Aged, Aneurysm, Ruptured/diagnosis, Aneurysm, Ruptured/physiopathology, Blood Glucose/metabolism, Brain/physiopathology, Brain Ischemia/diagnosis, Brain Ischemia/physiopathology, Cohort Studies, Coma/diagnosis, Coma/physiopathology, Critical Care, Female, Follow-Up Studies, Humans, Intracranial Aneurysm/diagnosis, Intracranial Aneurysm/physiopathology, Lactic Acid/metabolism, Male, Microdialysis, Middle Aged, Monitoring, Physiologic, Oxygen Consumption/physiology, Point-of-Care Testing, Prospective Studies, Pyruvic Acid/metabolism, Subarachnoid Hemorrhage/diagnosis, Subarachnoid Hemorrhage/physiopathology, Tomography, X-Ray Computed
Pubmed
Création de la notice
09/12/2016 13:48
Dernière modification de la notice
20/08/2019 14:52
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