Artikel
The impact of cerebral microdialysis in the acute neurosurgical intensive care setting –fact or fiction?
Der Einfluss der zerebralen Mikrodialyse im akuten neurointensivmedizinischen Setting – Realität oder Fiktion?
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Autoren
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Arthur Hosmann
- Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
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Johannes Herta
- Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
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Andrea Reinprecht
- Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
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Walter Plöchl
- Medizinische Universität Innsbruck, Anästhesie, Wien, Austria
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Andreas Gruber
- Kepler Universitätsklinikum, Neurochirurgie, Linz, Austria
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Karl Rössler
- Medizinische Universität Innsbruck, Neurochirurgie, Wien, Austria
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
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Objective: Multimodality neuromonitoring is crucial in the management of critically ill neurosurgical patients under intensive care unit conditions. While brain tissue oxygen tension (pbrO2) monitoring has already entered the clinical routine, this is not the case for cerebral microdialysis. However, many discrepancies between pbrO2 and cerebral metabolism are observed in the clinical setting.
Methods: Multimodality neuromonitoring data were analyzed in 35 patients suffering severe subarachnoid hemorrhage. The impact on cerebral metabolism and tissue oxygenation of diagnostic and therapeutic interventions, such as intrahospital transports, oral nimodipine administration, and selective intra-arterial papaverine-hydrochloride infusion were systematically analyzed.
Results: During intrahospital transports significant increase of intracranial pressure occurred. Although pbrO2 was not impaired, significant changes of cerebral glucose, lactate, and glycerol were evident.
Oral nimodipine administration induced significant decrease of cerebral perfusion pressure. In already compromised patients, nimodipine had detrimental effects on cerebral metabolism.
Endovascular rescue therapy for severe cerebral vasospasm, using intra-arterial papaverine-hydrochloride, showed only transient improvement of cerebral metabolism while pbrO2 remained unchanged.
Conclusion: Cerebral microdialysis provides valuable information beyond pbrO2 in the clinical setting and may therefore have a direct impact on our neurointensive care management. It allows to evaluate the individual effects of diagnostic and therapeutic interventions and personalize targeted therapy to optimize patients’ outcome.
