title: Pericontusional brain tissue exhibits persistent elevation of lactate/pyruvate ratio independent of cerebral perfusion pressure.
abstract: OBJECTIVE
  To determine whether pericontusional tissue exhibits neurochemical responsiveness to changes in cerebral perfusion pressure as measured by microdialysis lactate/pyruvate ratio.
  
  
  METHODS
  Prospective monitoring with retrospective data analysis.
  
  
  METHODS
  Single-center academic neurologic intensive care unit.
  
  
  METHODS
  Twenty-one patients with severe traumatic brain injury (Glasgow Coma Scale score 3-8).
  
  
  METHODS
  None.
  
  
  RESULTS
  Cerebral microdialysis was performed for the initial 7 days after traumatic brain injury. Thirteen patients had microdialysis probes in normal tissue and eight had two probes, one of which was located in pericontusional tissue. Retrospective analysis was performed to determine if microdialysis levels in pericontusional tissue demonstrates higher levels of lactate/pyruvate ratio than normal tissue and if lactate/pyruvate ratio increased with reductions in cerebral perfusion pressure. Univariate analysis revealed higher values for glutamate and lactate/pyruvate ratio in pericontusional tissue compared with normal tissue. However, based on the mixed-effects model analysis, the percent time of elevated lactate/pyruvate ratio was significantly higher in pericontusional tissue (40 +/- 59% vs. 17 +/- 37%, p < .05), and the mean lactate/pyruvate ratio values showed only a trend relationship (62 +/- 134 vs. 34 +/- 78, p < .06). When examined by cerebral perfusion pressure threshold, cerebral perfusion pressure <60 mm Hg was not associated with higher lactate/pyruvate ratio values in normal or pericontusional tissue. In addition, no single cerebral perfusion pressure threshold was associated with a significant reduction in lactate/pyruvate ratio in either pericontusional or normal tissue (p < .08).
  
  
  CONCLUSIONS
  Sustained increases in lactate/pyruvate ratio occurred more frequently in pericontusional tissue compared with normal brain tissue. The lactate/pyruvate ratio was not related to cerebral perfusion pressure, nor was the percent time-burden of elevated lactate/pyruvate ratio related to any particular sustained cerebral perfusion pressure threshold. Lactate/pyruvate ratio values appear to be elevated despite cerebral perfusion pressure values customarily considered to be adequate.
authors.affiliation: UCLA, Division of Neurosurgery, USA. PVespa@mednet.ucla.edu
authors.forename: Paul M
authors.initials: PM
authors.lastname: Vespa
authors.forename: Kristine
authors.initials: K
authors.lastname: O'Phelan
authors.forename: David
authors.initials: D
authors.lastname: McArthur
authors.forename: Chad
authors.initials: C
authors.lastname: Miller
authors.forename: Matthew
authors.initials: M
authors.lastname: Eliseo
authors.forename: Daniel
authors.initials: D
authors.lastname: Hirt
authors.forename: Thomas
authors.initials: T
authors.lastname: Glenn
authors.forename: David A
authors.initials: DA
authors.lastname: Hovda
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D001921:Brain / Q000098:blood supply / Q000378:metabolism*; D001930:Brain Injuries / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D005260:Female; D015600:Glasgow Coma Scale; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007427:Intracranial Pressure; D019344:Lactic Acid / Q000032:analysis*; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D019289:Pyruvic Acid / Q000032:analysis*; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D019344:Lactic Acid; D019289:Pyruvic Acid