title: A technique for continuous bedside monitoring of global cerebral energy state.
abstract: BACKGROUND
  Cerebral cytoplasmatic redox state is a sensitive indicator of cerebral oxidative metabolism and is conventionally evaluated from the extracellular lactate/pyruvate (LP) ratio. In the present experimental study of global cerebral ischemia induced by hemorrhagic shock, we investigate whether the LP ratio obtained from microdialysis of cerebral venous blood may be used as a surrogate marker of global cerebral energy state.
  
  
  METHODS
  Six female pigs were anesthetized and vital parameters were recorded. Microdialysis catheters were placed in the left parietal lobe, the superior sagittal sinus, and the femoral artery. Hemorrhagic shock was achieved by bleeding the animals to a mean arterial pressure (MAP) of approximately 40 mmHg and kept at a MAP of about 30-40 mmHg for 90 min. The animals were resuscitated with autologous whole blood followed by 3 h of observation.
  
  
  RESULTS
  The LP ratio obtained from the intracerebral and intravenous catheters immediately increased during the period of hemorrhagic shock while the LP ratio in the arterial blood remained close to normal levels. At the end of the experiment, median LP ratio (interquartile range) obtained from the intracerebral, intravenous, and intra-arterial microdialysis catheters were 846 (243-1990), 309 (103-488), and 27 (21-31), respectively. There was a significant difference in the LP ratio obtained from the intravenous location and the intra-arterial location (P < 0.001).
  
  
  CONCLUSIONS
  During cerebral ischemia induced by severe hemorrhagic shock, intravascular microdialysis of the draining venous blood will exhibit changes of the LP ratio revealing the deterioration of global cerebral oxidative energy metabolism. In neurocritical care, this technique might be used to give information regarding global cerebral energy metabolism in addition to the regional information obtained from intracerebral microdialysis catheters. The technique might also be used to evaluate cerebral energy state in various critical care conditions when insertion of an intracerebral microdialysis catheter may be contraindicated, e.g., resuscitation after cardiac standstill, open-heart surgery, and multi-trauma.
authors.affiliation: Department of Anaesthesia and Intensive care, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. rajak@dadlnet.dk.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Jakobsen
authors.affiliation: Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. troels.nielsen@rsyd.dk.
authors.forename: Troels
authors.initials: T
authors.lastname: Halfeld Nielsen
authors.affiliation: Department of Anesthesiology, Regional Hospital of Randers, Skovlyvej 1, 8930, Randers NØ, Denmark. granfeldt@clin.au.dk.
authors.forename: Asger
authors.initials: A
authors.lastname: Granfeldt
authors.affiliation: Department of Anaesthesia and Intensive care, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. palle.toft@rsyd.dk.
authors.forename: Palle
authors.initials: P
authors.lastname: Toft
authors.affiliation: Department of Neurosurgery, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. carl-henrik.nordstrom@med.lu.se.
authors.forename: Carl-Henrik
authors.initials: CH
authors.lastname: Nordström
keywords: Cerebral energy state; Hemorrhagic shock; Ischemia; Microdialysis