Head injury monitoring using cerebral microdialysis and Paratrend multiparameter sensors.
BACKGROUND
Following head injury complex pathophysiological changes occur in brain metabolism. The objective of the study was to monitor brain metabolism using the Paratrend multiparameter sensor and microdialysis catheters.


METHODS
Following approval by the Local Ethics Committee and consent from the relatives, patients with severe head injury were studied using a triple bolt inserted into the frontal region, transmitting an intracranial pressure monitor, microdialysis (10 mm or 30 mm membrane; glucose, lactate, pyruvate, glutamate) catheter and Paratrend multiparameter (oxygen, carbon dioxide, pH and temperature) sensor. A Paratrend sensor was also inserted into the femoral artery for continuous blood gas analysis.


RESULTS
21 patients were studied with cerebral microdialysis for a total of 91 monitoring days (range 19 hours to 12 days). Of these, 14 patients were also studied with cerebral and arterial Paratrend sensors. The mean (+/- 95% confidence intervals) arterial and cerebral oxygen levels were 123 +/- 10.9 mmHg and 27.9 +/- 5.71 mmHg respectively. The arterial and cerebral carbon dioxide levels were 34.3 +/- 2.35 mmHg and 45.3 +/- 3.07 mmHg respectively. Episodes of systemic hypoxia and hypotension resulting in falls in cerebral oxygen and rises in cerebral carbon dioxide were rapidly detected by the arterial and cerebral Paratrend sensors. Systemic pyrexia was reflected in the brain with the cerebral Paratrend sensor reading 0.17 degree C (mean) higher than the arterial sensor. Elevations of cerebral glucose were detected, but the overall cerebral glucose was low (mean 1.57 +/- 0.53 mM 10 mm membrane; mean 1.95 +/- 0.68 mM 30 mm membrane) with periods of undetectable glucose in 6 patients. Lactate concentrations (mean 5.08 +/- 0.73 mM 10 mm membrane; mean 8.27 +/- 1.31 mM 30 mm membrane) were higher than glucose concentrations in all patients. The lactate/pyruvate ratio was 32.1 +/- 5.16 for the 10 mm membrane and 30.6 +/- 2.17 for the 30 mm membrane. Glutamate concentrations varied between patients (mean 15.0 +/- 10.5 microM 10 mm membrane; mean 28.8 +/- 17.8 microM 30 mm membrane).


CONCLUSIONS
The combination of microdialysis catheters and Paratrend sensors enabling the monitoring of substrate delivery and brain metabolism, and the detection of secondary metabolic insults has the potential to assist in the management of head-injured patients.
Hutchinson
P J
PJ
Academic Department of Neurosurgery, University of Cambridge, UK.
al-Rawi
P G
PG
O'Connell
M T
MT
Gupta
A K
AK
Maskell
L B
LB
Hutchinson
D B
DB
Pickard
J D
JD
Kirkpatrick
P J
PJ
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D015374:Biosensing Techniques / Q000295:instrumentation; D002405:Catheterization, Central Venous; D006259:Craniocerebral Trauma / Q000097:blood / Q000503:physiopathology*; D005260:Female; D015600:Glasgow Coma Scale; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D017551:Microdialysis / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D012887:Skull Fractures / Q000097:blood / Q000503:physiopathology
D005947:Glucose; D010100:Oxygen