Patterns of cerebral tissue oxygen tension and cytoplasmic redox state in bacterial meningitis

Autor: Troels Halfeld Nielsen, Frantz Rom Poulsen, Carl-Henrik Nordström, Mette Katrine Schulz, Åse Bengård Andersen, Lykke Larsen, Jens Schierbeck
Rok vydání: 2018
Předmět:
Male
Cytoplasm
medicine.medical_specialty
Intracranial Pressure
Ischemia
intracerebral microdialysis
medicine.disease_cause
Brain Ischemia
Cohort Studies
03 medical and health sciences
Oxygen Consumption
0302 clinical medicine
intracranial pressure
ischemia
Internal medicine
mitochondrial dysfunction
Pyruvic Acid
medicine
Humans
Lactic Acid
Prospective Studies
030212 general & internal medicine
Prospective cohort study
Aged
Intracranial pressure
Aged
80 and over
Brain Chemistry
Meningitis
Pneumococcal
business.industry
Streptococcus
cerebral tissue oxygenation
030208 emergency & critical care medicine
General Medicine
Oxygenation
Middle Aged
medicine.disease
Mitochondria
Oxygen tension
Treatment Outcome
Anesthesiology and Pain Medicine
Endocrinology
Female
Blood Gas Analysis
bacterial meningitis
Energy Metabolism
business
Oxidation-Reduction
Meningitis
Zdroj: Larsen, L, Nielsen, T H, Nordström, C-H, Andersen, Å B, Schierbeck, J, Schulz, M K & Rom Poulsen, F 2019, ' Patterns of cerebral tissue oxygen tension and cytoplasmic redox state in bacterial meningitis ', Acta Anaesthesiologica Scandinavica, vol. 63, no. 3, pp. 329-336 . https://doi.org/10.1111/aas.13278
ISSN: 0001-5172
Popis: Background: Compromised cerebral energy metabolism is common in patients with bacterial meningitis. In this study, simultaneous measurements of cerebral oxygen tension and lactate/pyruvate ratio were compared to explore whether disturbed energy metabolism was usually caused by insufficient tissue oxygenation or compromised oxidative metabolism of pyruvate indicating mitochondrial dysfunction. Subject and Methods: Ten consecutive patients with severe streptococcus meningitis were included in this prospective cohort study. Intracranial pressure, brain tissue oxygen tension (PbtO 2 ), and energy metabolism (intracerebral microdialysis) were continuously monitored in nine patients. A cerebral lactate/pyruvate (LP) ratio 30 simultaneously with pyruvate below lower normal level (70 µmol/L) was interpreted as biochemical indication of ischemia, and LP ratio >30 simultaneously with a normal or increased level of pyruvate was interpreted as mitochondrial dysfunction. The biochemical variables were compared with PbtO 2 simultaneously monitored within the same cerebral region. Results: In two cases, the LP ratio was normal during the whole study period and the simultaneously monitored PbtO 2 was 18 ± 6 mm Hg. In six cases, interpreted as mitochondrial dysfunction, the simultaneously monitored PbtO 2 was 20 ± 6 mm Hg and without correlation with the LP ratio. In one patient, exhibiting a pattern interpreted as ischemia, PbtO 2 decreased below 10 mm Hg and a correlation between LP and PbtO 2 was observed. Conclusion: This study demonstrated that compromised cerebral energy metabolism, evidenced by increased LP ratio, was common in patients with severe bacterial meningitis while not related to insufficient tissue oxygenation.
Databáze: OpenAIRE
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