User login
Nearly two-thirds of patients experience metabolic crisis after traumatic brain injury, even after receiving successful standard fluid resuscitation treatment.
SAN DIEGO—Early metabolic crisis is common after traumatic brain injury and may be more common if certain physiologic factors are present, researchers reported at the Society of Critical Care Medicine’s 40th Critical Care Congress.
Nathan R. Stein, a student from the Department of Bioengineering at the University of California, Los Angeles; David L. McArthur, PhD, from the Department of Neurosurgery; and Paul Vespa, MD, FCCM, from the Departments of Neurology and Neurosurgery at UCLA, performed cerebral microdialysis of normal-appearing white matter in 41 patients (33 men) with severe traumatic brain injury. They collected data for the first week after injury; in total, 5,723 hourly samples were analyzed.
Within the first 48 hours after injury, 66.85% of the participants had experienced metabolic crisis, defined as glucose concentrations less than 0.8 mmol/L and a lactate/pyruvate ratio higher than 40.
Standard Resuscitation Does Not Prevent Metabolic Crisis
Patients underwent standard fluid resuscitation protocol using saline and norepinephrine titrations for two hours to maintain central venous pressure and mean arterial pressure at safe levels. Although 93% of patients received successful resuscitation, a majority of patients experienced metabolic crisis for an average duration of 19.54 hours during the initial 48 hours after the injury.
“Our research suggests that successful fluid resuscitation in the first two days after a traumatic brain injury does not reduce the incidence of metabolic crisis,” Mr. Stein told Neurology Reviews.
Low brain glucose occurred in 92.68% of patients at an average of 82.79% of the total time of metabolic crisis, while elevated lactate/pyruvate ratio occurred in 70.73% of patients at an average of 43.95% of the time.
Triggers for Metabolic Crisis
Mr. Stein’s group also identified certain physiologic factors that may increase the risk for, and duration of, metabolic crisis, including intracranial pressure more than 20 mm Hg, blood glucose lower than 110 mg/dL, and fever higher than 38°C. Treating one or more of these conditions helped correct metabolic crisis.
“Despite being able to correct the metabolic crisis in more than 60% of patients over the next four days, the initial trauma’s deleterious effects on brain metabolism seem to persist for the first few days following injury,” Mr. Stein added.
“We will now turn to looking at how early treatment of specific physiologic triggers … within the first few hours postinjury may reduce the duration or severity of the initial metabolic crisis, and see if treatments, such as higher blood glucose goals or therapeutic hypothermia, help correct the metabolic crisis sooner,” he concluded.
Suggested Reading
De Fazio M, Rammo R, O’Phelan K, Bullock MR. Alterations in cerebral oxidative metabolism following traumatic brain injury. Neurocrit Care. 2011;14(1):91-96.
Lakshmanan R, Loo JA, Drake T, et al. Metabolic crisis after traumatic brain injury is associated with a novel microdialysis proteome. Neurocrit Care. 2010;12(3):324-336.
Nearly two-thirds of patients experience metabolic crisis after traumatic brain injury, even after receiving successful standard fluid resuscitation treatment.
SAN DIEGO—Early metabolic crisis is common after traumatic brain injury and may be more common if certain physiologic factors are present, researchers reported at the Society of Critical Care Medicine’s 40th Critical Care Congress.
Nathan R. Stein, a student from the Department of Bioengineering at the University of California, Los Angeles; David L. McArthur, PhD, from the Department of Neurosurgery; and Paul Vespa, MD, FCCM, from the Departments of Neurology and Neurosurgery at UCLA, performed cerebral microdialysis of normal-appearing white matter in 41 patients (33 men) with severe traumatic brain injury. They collected data for the first week after injury; in total, 5,723 hourly samples were analyzed.
Within the first 48 hours after injury, 66.85% of the participants had experienced metabolic crisis, defined as glucose concentrations less than 0.8 mmol/L and a lactate/pyruvate ratio higher than 40.
Standard Resuscitation Does Not Prevent Metabolic Crisis
Patients underwent standard fluid resuscitation protocol using saline and norepinephrine titrations for two hours to maintain central venous pressure and mean arterial pressure at safe levels. Although 93% of patients received successful resuscitation, a majority of patients experienced metabolic crisis for an average duration of 19.54 hours during the initial 48 hours after the injury.
“Our research suggests that successful fluid resuscitation in the first two days after a traumatic brain injury does not reduce the incidence of metabolic crisis,” Mr. Stein told Neurology Reviews.
Low brain glucose occurred in 92.68% of patients at an average of 82.79% of the total time of metabolic crisis, while elevated lactate/pyruvate ratio occurred in 70.73% of patients at an average of 43.95% of the time.
Triggers for Metabolic Crisis
Mr. Stein’s group also identified certain physiologic factors that may increase the risk for, and duration of, metabolic crisis, including intracranial pressure more than 20 mm Hg, blood glucose lower than 110 mg/dL, and fever higher than 38°C. Treating one or more of these conditions helped correct metabolic crisis.
“Despite being able to correct the metabolic crisis in more than 60% of patients over the next four days, the initial trauma’s deleterious effects on brain metabolism seem to persist for the first few days following injury,” Mr. Stein added.
“We will now turn to looking at how early treatment of specific physiologic triggers … within the first few hours postinjury may reduce the duration or severity of the initial metabolic crisis, and see if treatments, such as higher blood glucose goals or therapeutic hypothermia, help correct the metabolic crisis sooner,” he concluded.
Nearly two-thirds of patients experience metabolic crisis after traumatic brain injury, even after receiving successful standard fluid resuscitation treatment.
SAN DIEGO—Early metabolic crisis is common after traumatic brain injury and may be more common if certain physiologic factors are present, researchers reported at the Society of Critical Care Medicine’s 40th Critical Care Congress.
Nathan R. Stein, a student from the Department of Bioengineering at the University of California, Los Angeles; David L. McArthur, PhD, from the Department of Neurosurgery; and Paul Vespa, MD, FCCM, from the Departments of Neurology and Neurosurgery at UCLA, performed cerebral microdialysis of normal-appearing white matter in 41 patients (33 men) with severe traumatic brain injury. They collected data for the first week after injury; in total, 5,723 hourly samples were analyzed.
Within the first 48 hours after injury, 66.85% of the participants had experienced metabolic crisis, defined as glucose concentrations less than 0.8 mmol/L and a lactate/pyruvate ratio higher than 40.
Standard Resuscitation Does Not Prevent Metabolic Crisis
Patients underwent standard fluid resuscitation protocol using saline and norepinephrine titrations for two hours to maintain central venous pressure and mean arterial pressure at safe levels. Although 93% of patients received successful resuscitation, a majority of patients experienced metabolic crisis for an average duration of 19.54 hours during the initial 48 hours after the injury.
“Our research suggests that successful fluid resuscitation in the first two days after a traumatic brain injury does not reduce the incidence of metabolic crisis,” Mr. Stein told Neurology Reviews.
Low brain glucose occurred in 92.68% of patients at an average of 82.79% of the total time of metabolic crisis, while elevated lactate/pyruvate ratio occurred in 70.73% of patients at an average of 43.95% of the time.
Triggers for Metabolic Crisis
Mr. Stein’s group also identified certain physiologic factors that may increase the risk for, and duration of, metabolic crisis, including intracranial pressure more than 20 mm Hg, blood glucose lower than 110 mg/dL, and fever higher than 38°C. Treating one or more of these conditions helped correct metabolic crisis.
“Despite being able to correct the metabolic crisis in more than 60% of patients over the next four days, the initial trauma’s deleterious effects on brain metabolism seem to persist for the first few days following injury,” Mr. Stein added.
“We will now turn to looking at how early treatment of specific physiologic triggers … within the first few hours postinjury may reduce the duration or severity of the initial metabolic crisis, and see if treatments, such as higher blood glucose goals or therapeutic hypothermia, help correct the metabolic crisis sooner,” he concluded.
Suggested Reading
De Fazio M, Rammo R, O’Phelan K, Bullock MR. Alterations in cerebral oxidative metabolism following traumatic brain injury. Neurocrit Care. 2011;14(1):91-96.
Lakshmanan R, Loo JA, Drake T, et al. Metabolic crisis after traumatic brain injury is associated with a novel microdialysis proteome. Neurocrit Care. 2010;12(3):324-336.
Suggested Reading
De Fazio M, Rammo R, O’Phelan K, Bullock MR. Alterations in cerebral oxidative metabolism following traumatic brain injury. Neurocrit Care. 2011;14(1):91-96.
Lakshmanan R, Loo JA, Drake T, et al. Metabolic crisis after traumatic brain injury is associated with a novel microdialysis proteome. Neurocrit Care. 2010;12(3):324-336.