scholarly journals Cerebral Extracellular Lactate Increase is Predominantly Nonischemic in Patients with Severe Traumatic Brain Injury

2013 ◽  
Vol 33 (11) ◽  
pp. 1815-1822 ◽  
Author(s):  
Nathalie Sala ◽  
Tamarah Suys ◽  
Jean-Baptiste Zerlauth ◽  
Pierre Bouzat ◽  
Mahmoud Messerer ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Brain Perfusion ◽  
Cerebral Microdialysis ◽  
Lactate Metabolism ◽  
Perfusion Computed Tomography ◽  
Extracellular Lactate ◽  
Ct Brain ◽  
Brain Lactate

Growing evidence suggests that endogenous lactate is an important substrate for neurons. This study aimed to examine cerebral lactate metabolism and its relationship with brain perfusion in patients with severe traumatic brain injury (TBI). A prospective cohort of 24 patients with severe TBI monitored with cerebral microdialysis (CMD) and brain tissue oxygen tension (PbtO2) was studied. Brain lactate metabolism was assessed by quantification of elevated CMD lactate samples (>4 mmol/L); these were matched to CMD pyruvate and PbtO2 values and dichotomized as glycolytic (CMD pyruvate > 119 μmol/L vs. low pyruvate) and hypoxic (PbtO2 < 20 mm Hg vs. nonhypoxic). Using perfusion computed tomography (CT), brain perfusion was categorized as oligemic, normal, or hyperemic, and was compared with CMD and PbtO2 data. Samples with elevated CMD lactate were frequently observed (41 ±8%), and we found that brain lactate elevations were predominantly associated with glycolysis and normal PbtO2 (73 ± 8%) rather than brain hypoxia (14 ±6%). Furthermore, glycolytic lactate was always associated with normal or hyperemic brain perfusion, whereas all episodes with hypoxic lactate were associated with diffuse oligemia. Our findings suggest predominant nonischemic cerebral extracellular lactate release after TBI and support the concept that lactate may be used as an energy substrate by the injured human brain.

Cerebral Microdialysis Effects of Propofol versus Midazolam in Severe Traumatic Brain Injury

2012 ◽  
Vol 29 (6) ◽  
pp. 1105-1110 ◽  
Author(s):  
Michèle Tanguy ◽  
Philippe Seguin ◽  
Bruno Laviolle ◽  
Jean-Paul Bleichner ◽  
Xavier Morandi ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Cerebral Microdialysis

scholarly journals Abnormalities on Perfusion CT and Intervention for Intracranial Hypertension in Severe Traumatic Brain Injury

2020 ◽  
Vol 9 (6) ◽  
pp. 2000
Author(s):  
Shannon Cooper ◽  
Cino Bendinelli ◽  
Andrew Bivard ◽  
Mark Parsons ◽  
Zsolt J. Balogh
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Hypertension ◽  
Severe Traumatic Brain Injury ◽  
Injury Severity ◽  
Intervention Group ◽  
Small Sample ◽  
Perfusion Computed Tomography ◽  
Group I ◽  
Second Tier

The role of invasive intracranial pressure (ICP) monitoring in patients with severe traumatic brain injury (STBI) remain unclear. Perfusion computed tomography (CTP) provides crucial information about the cerebral perfusion status in these patients. We hypothesised that CTP abnormalities would be associated with the severity of intracranial hypertension (ICH). To investigate this hypothesis, twenty-eight patients with STBI and ICP monitors were investigated with CTP within 48 h from admission. Treating teams were blind to these results. Patients were divided into five groups based on increasing intervention required to control ICH and were compared. Group I required no intervention above routine sedation, group II required a single first tier intervention, group III required multiple different first-tier interventions, group IV required second-tier medical therapy and group V required second-tier surgical therapy. Analysis of the results showed demographics and injury severity did not differ among groups. In group I no patients showed CTP abnormality, while patients in all other groups had abnormal CTP (p = 0.003). Severe ischaemia observed on CTP was associated with increasing intervention for ICH. This study, although limited by small sample size, suggests that CTP abnormalities are associated with the need to intervene for ICH. Larger scale assessment of our results is warranted to potentially avoid unnecessary invasive procedures in head injury patients.

The Usefulness of CT Brain Perfusion Image on Evaluation of Traumatic Brain Injury

2010 ◽  
Vol 6 (1) ◽  
pp. 6 ◽  
Author(s):  
Ji Woong Oh ◽  
Hyen Ho Jung ◽  
Jhin Soo Pyen ◽  
Chul Hu ◽  
Kum Whang ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Perfusion ◽  
Perfusion Image ◽  
Ct Brain

scholarly journals When a Slice Is Not Enough! Comparison of Whole-Brain versus Standard Limited-Slice Perfusion Computed Tomography in Patients with Severe Traumatic Brain Injury

2019 ◽  
Vol 8 (5) ◽  
pp. 701
Author(s):  
Shannon Cooper ◽  
Cino Bendinelli ◽  
Andrew Bivard ◽  
Mark Parsons ◽  
Zsolt J. Balogh
Keyword(s):  
Computed Tomography ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Brain Slices ◽  
Brain Perfusion ◽  
Whole Brain ◽  
Perfusion Abnormality ◽  
Perfusion Computed Tomography ◽  
Additional Information ◽  
Severe Tbi

Introduction: Cerebral perfusion computed tomography (PCT) provides crucial information in acute stroke and has an increasing role in traumatic brain injury (TBI) management. Most studies on TBI patients utilize 64-slice scanners, which are limited to four brain slices (limited-brain PCT, LBPCT). Newer 320-slice scanners depict the whole brain perfusion status (WBPCT). We aimed to identify the additional information gained with WBPCT when compared to LBPCT. Patients and methods: Forty-nine patients with severe TBI were investigated within 48 h from admission with WBPCT. Findings from LBPCT were compared with findings from WBPCT. Results: A perfusion abnormality was identified in 39 (80%) and 37 (76%) patients by WBPCT and LBPCT, respectively (p = 0.8). There were 90 and 68 perfusion abnormalities identified by WBPCT and LBPCT, respectively (p < 0.001). In the 39 patients with a perfusion abnormality detected by WBPCT, 15 (38%) had further perfusion abnormalities outside the LBPCT area of coverage. Thirty-six (92%) patients had a larger perfusion abnormality upon WBPCT compared with LBPCT. Additional information gained showed some statistically significant correlation with clinical outcome. Conclusions: In severe TBI patients, WBPCT provides extra information compared to LBPC. The limitations of LBPCT should be considered when evaluating studies reporting on PCT findings and their association with outcomes.

scholarly journals Cerebral microdialysis of interleukin (IL)-1ß and IL-6: extraction efficiency and production in the acute phase after severe traumatic brain injury in rats

2008 ◽  
Vol 150 (12) ◽  
pp. 1277-1284 ◽  
Author(s):  
Hedy Folkersma ◽  
John J. P. Brevé ◽  
Fred J. H. Tilders ◽  
Leela Cherian ◽  
Claudia S. Robertson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Acute Phase ◽  
Severe Traumatic Brain Injury ◽  
Extraction Efficiency ◽  
Cerebral Microdialysis

Treatment of Severe Traumatic Brain Injury in the Scandinavian Countries, with Special Emphasis on the Lund Concept

Neurotrauma ◽  
2018 ◽  
pp. 29-40
Author(s):  
Magnus Olivecrona ◽  
Per-Olof Grände
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Fluid Therapy ◽  
Cerebral Perfusion ◽  
Brain Perfusion ◽  
Brain Trauma ◽  
Volume Control ◽  
Brain Trauma Foundation ◽  
The Brain

The Lund concept (LC) and the Brain Trauma Foundation (BTF) guidelines are used in Scandinavia and the Nordic countries to treat severe brain trauma (s-TBI). In this chapter, the authors focus on the LC developed in Scandinavia. When introduced in 1992, it was a theoretical approach, based mainly on principles of brain volume control and of optimization of brain perfusion. The BTF guidelines presented in 1996 were based on meta-analytic approaches. The LC gives relatively strict outlines regarding cerebral perfusion pressure, fluid therapy, ventilation, sedation, nutrition, the use of vasopressors, and osmotherapy. The treatment is standardized, with less need for individualization.

Multimodality Monitoring in Severe Traumatic Brain Injury

Neurotrauma ◽  
2019 ◽  
pp. 193-208
Author(s):  
Abdelhakim Khellaf ◽  
Peter J. A. Hutchinson ◽  
Adel Helmy
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Cerebral Perfusion ◽  
Cerebral Microdialysis ◽  
Multimodality Monitoring ◽  
Concurrent Use ◽  
Brain Tissue Oxygen Tension ◽  
Current Guidelines ◽  
The Brain

The central aspects of severe traumatic brain injury (sTBI) management are control of intracranial pressure (ICP) and maintenance of adequate delivery of glucose and oxygen to the brain. Brain multimodality monitoring (MMM) is an important tool defined by the concurrent use of multiple brain monitors, typically ICP monitoring, cerebral perfusion pressure (CPP) monitoring (via ICP and invasive arterial monitoring), brain tissue oxygen tension (PbtO2) monitoring, and cerebral microdialysis for brain biochemistry. The aim of brain MMM in patients with sTBI is to help optimize conditions for brain recovery within the neurocritical care unit, prevent secondary injury, and provide individualized therapeutic targets. In this chapter, the authors further elaborate on these concepts and current guidelines with application to a case example.

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