Changes in cerebral interstitial glycerol concentration in head-injured patients; correlation with secondary events

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: To investigate the association between the occurrence of secondary events, clinical outcome and the interstitial glycerol levels as measured with cerebral microdialysis.

DESIGN: All patients received a ventriculostomy, a Camino pressure sensor and a CMA 70 microdialysis catheter. Intracranial pressure (ICP), cerebral perfusion pressure (CPP), blood pressure and arterial oxygen saturation (SaO2) were continuously monitored. Hourly microdialysis samples were collected and glycerol concentrations analyzed on-line. Glasgow Coma Score (GCS) scoring, blood gas and other laboratory analyses or investigations followed the routine of the intensive care unit. The Glasgow Outcome Scale (GOS) was assessed 6 months after injury.

SETTING: Intensive Care Unit and Department of Neurosurgery, VU University Hospital.

PATIENTS: Fifteen consecutive patients with severe traumatic brain injury and a GCS of 8 or less.

RESULTS: No association was found between low CPP, high ICP, low PaCO2, low SaO2 or rise in temperature and the level of interstitial glycerol. In patients with a favorable outcome, the glycerol concentration never reached a level above 150 micromol/l, whereas a peak glycerol level above 150 micromol/l had a positive predictive value of 100% for an unfavorable outcome. The average of the area under the curve during the first 24 h of monitoring was significantly higher in the group with an unfavorable outcome (Kolmogorov-Smirnov test, p=0.044).

CONCLUSION: Measuring interstitial glycerol for early detection of secondary adverse events, which possibly lead to secondary brain damage, does not seem useful. A peak level of interstitial glycerol above 150 micromol/l has a positive predictive value of 100% for an unfavorable outcome and hence indicates the severity of the parenchymal damage.

Original languageEnglish
Pages (from-to)1825-8
Number of pages4
JournalIntensive Care Medicine
Volume29
Issue number10
DOIs
Publication statusPublished - Oct 2003

Cite this

@article{87485a0d56074cfdb1983f474c172346,
title = "Changes in cerebral interstitial glycerol concentration in head-injured patients; correlation with secondary events",
abstract = "OBJECTIVE: To investigate the association between the occurrence of secondary events, clinical outcome and the interstitial glycerol levels as measured with cerebral microdialysis.DESIGN: All patients received a ventriculostomy, a Camino pressure sensor and a CMA 70 microdialysis catheter. Intracranial pressure (ICP), cerebral perfusion pressure (CPP), blood pressure and arterial oxygen saturation (SaO2) were continuously monitored. Hourly microdialysis samples were collected and glycerol concentrations analyzed on-line. Glasgow Coma Score (GCS) scoring, blood gas and other laboratory analyses or investigations followed the routine of the intensive care unit. The Glasgow Outcome Scale (GOS) was assessed 6 months after injury.SETTING: Intensive Care Unit and Department of Neurosurgery, VU University Hospital.PATIENTS: Fifteen consecutive patients with severe traumatic brain injury and a GCS of 8 or less.RESULTS: No association was found between low CPP, high ICP, low PaCO2, low SaO2 or rise in temperature and the level of interstitial glycerol. In patients with a favorable outcome, the glycerol concentration never reached a level above 150 micromol/l, whereas a peak glycerol level above 150 micromol/l had a positive predictive value of 100{\%} for an unfavorable outcome. The average of the area under the curve during the first 24 h of monitoring was significantly higher in the group with an unfavorable outcome (Kolmogorov-Smirnov test, p=0.044).CONCLUSION: Measuring interstitial glycerol for early detection of secondary adverse events, which possibly lead to secondary brain damage, does not seem useful. A peak level of interstitial glycerol above 150 micromol/l has a positive predictive value of 100{\%} for an unfavorable outcome and hence indicates the severity of the parenchymal damage.",
keywords = "Adolescent, Adult, Aged, Brain/metabolism, Brain Injuries/metabolism, Female, Glycerol/metabolism, Humans, Injury Severity Score, Male, Middle Aged, Prospective Studies, Time Factors",
author = "Peerdeman, {Saskia M} and Girbes, {Armand R J} and Polderman, {Kees H} and Vandertop, {W Peter}",
year = "2003",
month = "10",
doi = "10.1007/s00134-003-1850-8",
language = "English",
volume = "29",
pages = "1825--8",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer Verlag",
number = "10",

}

Changes in cerebral interstitial glycerol concentration in head-injured patients; correlation with secondary events. / Peerdeman, Saskia M; Girbes, Armand R J; Polderman, Kees H; Vandertop, W Peter.

In: Intensive Care Medicine, Vol. 29, No. 10, 10.2003, p. 1825-8.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Changes in cerebral interstitial glycerol concentration in head-injured patients; correlation with secondary events

AU - Peerdeman, Saskia M

AU - Girbes, Armand R J

AU - Polderman, Kees H

AU - Vandertop, W Peter

PY - 2003/10

Y1 - 2003/10

N2 - OBJECTIVE: To investigate the association between the occurrence of secondary events, clinical outcome and the interstitial glycerol levels as measured with cerebral microdialysis.DESIGN: All patients received a ventriculostomy, a Camino pressure sensor and a CMA 70 microdialysis catheter. Intracranial pressure (ICP), cerebral perfusion pressure (CPP), blood pressure and arterial oxygen saturation (SaO2) were continuously monitored. Hourly microdialysis samples were collected and glycerol concentrations analyzed on-line. Glasgow Coma Score (GCS) scoring, blood gas and other laboratory analyses or investigations followed the routine of the intensive care unit. The Glasgow Outcome Scale (GOS) was assessed 6 months after injury.SETTING: Intensive Care Unit and Department of Neurosurgery, VU University Hospital.PATIENTS: Fifteen consecutive patients with severe traumatic brain injury and a GCS of 8 or less.RESULTS: No association was found between low CPP, high ICP, low PaCO2, low SaO2 or rise in temperature and the level of interstitial glycerol. In patients with a favorable outcome, the glycerol concentration never reached a level above 150 micromol/l, whereas a peak glycerol level above 150 micromol/l had a positive predictive value of 100% for an unfavorable outcome. The average of the area under the curve during the first 24 h of monitoring was significantly higher in the group with an unfavorable outcome (Kolmogorov-Smirnov test, p=0.044).CONCLUSION: Measuring interstitial glycerol for early detection of secondary adverse events, which possibly lead to secondary brain damage, does not seem useful. A peak level of interstitial glycerol above 150 micromol/l has a positive predictive value of 100% for an unfavorable outcome and hence indicates the severity of the parenchymal damage.

AB - OBJECTIVE: To investigate the association between the occurrence of secondary events, clinical outcome and the interstitial glycerol levels as measured with cerebral microdialysis.DESIGN: All patients received a ventriculostomy, a Camino pressure sensor and a CMA 70 microdialysis catheter. Intracranial pressure (ICP), cerebral perfusion pressure (CPP), blood pressure and arterial oxygen saturation (SaO2) were continuously monitored. Hourly microdialysis samples were collected and glycerol concentrations analyzed on-line. Glasgow Coma Score (GCS) scoring, blood gas and other laboratory analyses or investigations followed the routine of the intensive care unit. The Glasgow Outcome Scale (GOS) was assessed 6 months after injury.SETTING: Intensive Care Unit and Department of Neurosurgery, VU University Hospital.PATIENTS: Fifteen consecutive patients with severe traumatic brain injury and a GCS of 8 or less.RESULTS: No association was found between low CPP, high ICP, low PaCO2, low SaO2 or rise in temperature and the level of interstitial glycerol. In patients with a favorable outcome, the glycerol concentration never reached a level above 150 micromol/l, whereas a peak glycerol level above 150 micromol/l had a positive predictive value of 100% for an unfavorable outcome. The average of the area under the curve during the first 24 h of monitoring was significantly higher in the group with an unfavorable outcome (Kolmogorov-Smirnov test, p=0.044).CONCLUSION: Measuring interstitial glycerol for early detection of secondary adverse events, which possibly lead to secondary brain damage, does not seem useful. A peak level of interstitial glycerol above 150 micromol/l has a positive predictive value of 100% for an unfavorable outcome and hence indicates the severity of the parenchymal damage.

KW - Adolescent

KW - Adult

KW - Aged

KW - Brain/metabolism

KW - Brain Injuries/metabolism

KW - Female

KW - Glycerol/metabolism

KW - Humans

KW - Injury Severity Score

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Time Factors

U2 - 10.1007/s00134-003-1850-8

DO - 10.1007/s00134-003-1850-8

M3 - Article

VL - 29

SP - 1825

EP - 1828

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 10

ER -