Enteral nutrition increases interstitial brain glucose levels in poor-grade subarachnoid hemorrhage patients.
Low brain tissue glucose levels after acute brain injury are associated with poor outcome. Whether enteral nutrition (EN) reliably increases cerebral glucose levels remains unclear. In this retrospective analysis of prospectively collected observational data, we investigate the effect of EN on brain metabolism in 17 poor-grade subarachnoid hemorrhage (SAH) patients undergoing cerebral microdialysis (CMD) monitoring. CMD-values were obtained hourly. A nutritional intervention was defined as the clinical routine administration of EN without supplemental parenteral nutrition. Sixty-three interventions were analyzed. The mean amount of EN per intervention was 472.4 ± 10.7 kcal. CMD-glucose levels significantly increased from 1.59 ± 0.13 mmol/l at baseline to a maximum of 2.03 ± 0.2 mmol/l after 5 h (p < 0.001), independently of insulin-treatment, baseline serum glucose, baseline brain metabolic distress (CMD-lactate-to-pyruvate-ratio (LPR) > 40) and the microdialysis probe location. The increase in CMD-glucose was directly dependent on the magnitude of increase of serum glucose levels (p = 0.007). No change in CMD-lactate, CMD-pyruvate, CMD-LPR, or CMD-glutamate (p > 0.4) was observed. Routine EN also increased CMD-glucose even if baseline concentrations were critically low ( < 0.7 mmol/l, neuroglucopenia; p < 0.001). These results may have treatment implications regarding glucose management of poor-grade aneurysmal SAH patients.
1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Mario
M
Kofler
1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Alois J
AJ
Schiefecker
1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Ronny
R
Beer
1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Maxime
M
Gaasch
2 Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.
Paul
P
Rhomberg
3 Fresenius Kabi, Bad Homburg vor der Höhe, Germany.
John
J
Stover
1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Bettina
B
Pfausler
4 Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
Claudius
C
Thomé
1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Erich
E
Schmutzhard
1 Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Raimund
R
Helbok
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001923:Brain Chemistry / Q000187:drug effects*; D004750:Enteral Nutrition; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D005791:Patient Care; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000145:classification / Q000178:diet therapy* / Q000378:metabolism*
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D005947:Glucose
Cerebral microdialysis; enteral nutrition; glucose transport; neurochemistry; subarachnoid hemorrhage