Intracerebral microdialysis and intracranial compliance monitoring of patients with traumatic brain injury.
OBJECTIVE
The aims of this study were to get an impression of the relationships between intracranial compliance (IC) and Lactate/Pyruvate (L/P) ratio and temperature and L/P ratio, and to determine if patients with low IC had an increased vulnerability for the secondary insult hyperthermia (as reflected in the L/P ratio). The effects of coma treatment on the results were also studied.


METHODS
Ten TBI patients were monitored for IC, in vivo microdialysis (MD) and bladder temperature. Mean Glasgow Coma Scale (GCS) score was 7 (range 4-10). Three patients underwent induced coma treatment. Three statistical models were used to look at the relationships between IC, temperature and L/P ratio in patients with and without coma.


RESULTS
We found that with high temperature L/P ratios increased as IC decreased (P < 0.0001). The patients with coma treatment had significantly higher average L/P ratios (P < 0.02). The effect of IC on the L/P ratio differed by coma treatment (P < 0.02). The temperature effect was not dependent on coma treatment (P < 0.49).


CONCLUSIONS
These findings suggest the importance of avoiding hyperthermia in TBI patients, especially in patients with low or decreased IC (monitored or anticipated). The present technical solution seems promising for analysis of complex clinical data.
Department of Neurosurgery, Uppsala University Hospital, S-751 85 Uppsala, Sweden.
Kontsantin
K
Salci
Pelle
P
Nilsson
Timothy
T
Howells
Elisabeth
E
Ronne-Engström
Ian
I
Piper
Charles F
CF
Contant
Per
P
Enblad
D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D003128:Coma / Q000503:physiopathology; D003187:Compliance; D005260:Female; D005334:Fever / Q000209:etiology / Q000503:physiopathology; D015600:Glasgow Coma Scale; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D017551:Microdialysis / Q000379:methods*; D008875:Middle Aged; D015233:Models, Statistical; D008991:Monitoring, Physiologic / Q000379:methods*; D019289:Pyruvic Acid / Q000378:metabolism; D012307:Risk Factors; D012720:Severity of Illness Index
D019344:Lactic Acid; D019289:Pyruvic Acid