Significance and possibilities to examine brain metabolism in neurointensive care by microdialysis
Authors:
A. Hejčl 1,7,8,9; P. Kelbich 3,4,5; M. Bolcha 1; J. Procházka 2; E. Hušková 2; J. Peruthová 4,6; M. Sameš 1
Authors‘ workplace:
Neurochirurgická klinika Univerzity J. E. Purkyně, Krajská zdravotní, a. s. - Masarykova nemocnice v Ústí nad Labem, o. z.
1; Oddělení intenzivní medicíny, Krajská zdravotní, a. s. - Masarykova nemocnice v Ústí nad Labem, o. z.
2; Oddělení klinické biochemie, Krajská zdravotní, a. s. - Masarykova nemocnice v Ústí nad Labem, o. z.
3; Oddělení klinické biochemie, hematologie a imunologie Nemocnice Kadaň s. r. o.
4; Ústav klinické imunologie a alergologie, Lékařská fakulta v Hradci Králové, Univerzita Karlova v Praze
5; Fakulta chemicko-technologická, Univerzita Pardubice
6; Centrum klinického výzkumu ICRC, Brno
7; Ústav experimentální medicíny AVČR, v. v. i., Praha
8; Neurochirurgická klinika 1. lékařské fakulty Univerzity Karlovy a Ústřední vojenské nemocnice v Praze
9
Published in:
Klin. Biochem. Metab., 21 (42), 2013, No. 1, p. 13-20
Overview
Objective:
1st Introducing microdialysis and its use in neurosurgery, or neurointensive care, respectively, to professionals in the field of biochemistry. 2nd Introduce the hypothesis on creatinphosphate, an alternative source of energy for the brain tissue.
Design:
Review article
Methods:
Collection of samples of the extracellular fluid enables examination of metabolites of the glucose oxidative metabolism with the aim of detecting early signs of brain ischemia. Microdialysis is used predominantly in patients with brain injury and subarachnoid hemorrhage after aneurysm rupture. Nonetheless, the samples may be examined for a wide scale of metabolites and biological active substances and extend our knowledge of brain metabolism.
Results:
We summarize the current knowledge on the use of microdialysis in neurointensive care of neurosurgical patients, its influence on the therapy and its predictive meaning. In the experimental work we focused on the metabolism of creatine phosphate, which, according to our first observations, can represent alternative energy to glucose oxidative metabolism, as demonstrated on 2 case reports.
Conclusions:
Microdialysis provides direct and continuous online monitoring of brain metabolism in everyday clinical practice. Standard diagnostics can be extended for a spectrum of various other metabolites; the metabolism of creatine phosphate may, according to our first observations, be an alternative source of energy for the brain.
Keywords:
microdialysis, neurointensive care, brain metabolism, glucose metabolism, creatine phosphate system
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