Cerebrospinal fluid lactate concentration after withdrawal of metabolic suppressive therapy in subarachnoid hemorrhage.
Hyperglycolysis is a known phenomenon after severe subarachnoid hemorrhage (SAH) and after brain injury. It is characterized by decreased oxidative metabolism and relatively increased anaerobic glycolysis. Metabolic suppressive therapy reduces the cerebral metabolic rate of oxygen (CMRO(2)) and the cerebral metabolic rate of glucose (CMRGluc). If CMRO(2) is suppressed after SAH, withdrawal of metabolic suppressive therapy could lead to the accumulation of lactate. In this project, we assessed the relationship between the withdrawal of metabolic suppressive therapy and cerebrospinal fluid (CSF) lactate concentration. A prospective observational database containing 262 patients with SAH was retrospectively analyzed. CSF lactate levels were compared with the daily dose of metabolic suppressive therapy. Outcome was assessed with the Glasgow Outcome Scale (GOS). In 56% of patients an increase in CSF lactate (mean: 3.2 ± 0.9 mmol/L) after withdrawal of metabolic suppressive therapy was observed. Mean Glasgow Outcome Score (GOS) was lower in patients with an increase in CSF lactate concentration (>0.5 mmol/L) after withdrawal of metabolic suppressive therapy (p = 0.095). In 88% of patients who died during the first 30 days after SAH, a CSF lactate elevation of more than 0.5 mmol/L after withdrawal of metabolic suppressive therapy was found (p = 0.071).
Department of Neurosurgery, University Hospital Giessen-Marburg, Klinikstrasse 29, Giessen, Germany. marco.stein@neuro.med.uni-giessen.de
Marco
M
Stein
Julia
J
Schomacher
Wolfram
W
Scharbrodt
Matthias
M
Preuss
Matthias F
MF
Oertel
D000328:Adult; D000368:Aged; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D023261:Glasgow Outcome Scale; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007362:Intensive Care Units; D019344:Lactic Acid / Q000134:cerebrospinal fluid*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D019370:Observation; D015742:Propofol / Q000134:cerebrospinal fluid; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000134:cerebrospinal fluid* / Q000378:metabolism / Q000628:therapy*; D013375:Substance Withdrawal Syndrome / Q000134:cerebrospinal fluid; D013997:Time Factors; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D019344:Lactic Acid; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol