Abstract
Microdialysis is a powerful technique, which enables the chemistry of the extracellular space to be measured directly. Applying this technique to patients in neurointensive care has increased our understanding of the pathophysiology of traumatic brain injury and spontaneous hemorrhage. In parallel, it is important to determine the place of microdialysis in assisting in the management of patients on an individual intention to treat basis. This is made possible by the availability of analyzers which can measure the concentration of glucose, pyruvate, lactate, and glutamate at the bedside. Samples can then be stored for later analysis of other substrate and metabolites e.g., other amino acids and cytokines. The objective of this paper is to review the fundamental literature pertinent to the clinical application of microdialysis in neurointensive care and to give recommendations on how the technique can be applied to assist in patient management and contribute to outcome. A literature search detected 1,933 publications of which 55 were used for data abstraction and analysis. The role of microdialysis was evaluated in three conditions (traumatic brain injury, subarachnoid hemorrhage, and intracerebral hemorrhage) and recommendations focused on three fundamental areas (relationship to outcome, application of microdialysis to guide therapy, and the ability of microdialysis to predict secondary deterioration).
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Acknowledgments
We acknowledge the assistance of Ibrahim Jalloh and Urban Ungerstedt with the literature review.
Conflict of interest
Peter Hutchinson is supported by an NIHR Research Professorship and by the Cambridge NIHR BRC. He is a director of Technicam, the manufacturer of the cranial access device. Kristine O’Phelan has declared no conflicts of interest.
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And the Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring Group members are listed in the Appendix.
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Appendix: And the Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring
Appendix: And the Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring
Peter Le Roux, MD, FACS
Brain and Spine Center
Suite 370, Medical Science Building
Lankenau Medical Center
100 East Lancaster Avenue, Wynnewood, PA 19096, USA
Tel: +1 610 642 3005
Fax: 610 642 3057
lerouxp@mlhs.org
David K Menon, MD, PhD, FRCP, FRCA, FFICM, FMedSci
Head, Division of Anaesthesia, University of Cambridge
Consultant, Neurosciences Critical Care Unit
Box 93, Addenbrooke’s Hospital
Cambridge CB2 2QQ, UK
dkm13@wbic.cam.ac.uk
Paul Vespa, MD, FCCM, FAAN, FNCS
Professor of Neurology and Neurosurgery
Director of Neurocritical Care
David Geffen School of Medicine at UCLA
Los Angeles, CA 90095 USA
PVespa@mednet.ucla.edu
Giuseppe Citerio, MD
Director NeuroIntensive Care Unit
Department of Anesthesia and Critical Care
Ospedale San Gerardo, Monza
Via Pergolesi 33, Monza 20900, Italy
g.citerio@hsgerardo.org
Mary Kay Bader RN, MSN, CCNS, FAHA, FNCS
Neuro/Critical Care CNS
Mission Hospital
Mission Viejo CA 92691, USA
Marykay.Bader@stjoe.org
Gretchen M. Brophy, PharmD, BCPS, FCCP, FCCM
Professor of Pharmacotherapy & Outcomes Science and Neurosurgery
Virginia Commonwealth University
Medical College of Virginia Campus
410 N. 12th Street
Richmond, Virginia 23298-0533 USA
gbrophy@vcu.edu
Michael N. Diringer, MD
Professor of Neurology, Neurosurgery & Anesthesiology
Chief, Neurocritical Care Section
Washington University
Dept. of Neurology, Campus Box 8111
660 S Euclid Ave
St Louis, MO 63110 USA
diringerm@neuro.wustl.edu
Nino Stocchetti, MD
Professor of Anesthesia and Intensive Care
Department of physiopathology and transplant
Milan University
Director Neuro ICU
Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico
Via F Sforza, 35 20122 Milan Italy
stocchet@policlinico.mi.it
Walter Videtta, MD
ICU Neurocritical Care
Hospital Nacional ‘Prof. a. Posadas’
El Palomar - Pcia. de Buenos Aires
Argentina
wvidetta@ar.inter.net
Rocco Armonda, MD
Department of Neurosurgery
MedStar Georgetown University Hospital
Medstar Health, 3800 Reservoir Road NW
Washington DC 20007
USA
Rocco.Armonda@gmail.com
Neeraj Badjatia, MD
Department of Neurology
University of Maryland Medical Center
22 S Greene St
Baltimore, MD, 21201
USA
nbadjatia@umm.edu
Julian Boesel, MD
Department of Neurology
Ruprect-Karls University
Hospital Heidelberg, Im Neuenheimer Feld 400
D-69120 Heidelberg
Germany
Julian.Boesel@med.uni-heidelberg.de
Randal Chesnut, MD, FCCM, FACS
Harborview Medical Center,
University of Washington Mailstop 359766
325 Ninth Ave
Seattle WA 98104-2499
USA
chesnutr@u.washington.edu
Sherry Chou, MD, MMSc
Department of Neurology
Brigham and Women’s Hospital
75 Francis Street,
Boston MA 02115
USA
schou1@partners.org
Jan Claassen, MD, PhD, FNCS
Assistant Professor of Neurology and Neurosurgery
Head of Neurocritical Care and Medical Director of the Neurological Intensive Care Unit
Columbia University College of Physicians & Surgeons
177 Fort Washington Avenue, Milstein 8 Center room 300
New York, NY 10032
USA
jc1439@cumc.columbia.edu
Marek Czosnyka, PhD
Department of Neurosurgery
University of Cambridge
Addenbrooke’s Hospital, Box 167
Cambridge, CB20QQ
United Kingdom
mc141@medschl.cam.ac.uk
Michael De Georgia, MD
Professor of Neurology
Director, Neurocritical Care Center
Co-Director, Cerebrovascular Center
University Hospital Case Medical Center
Case Western Reserve University School of Medicine
11100 Euclid Avenue
Cleveland, Ohio 44106
michael.degeorgia@uhhospitals.org
Anthony Figaji, MD, PhD
Head of Pediatric Neurosurgery
University of Cape Town
617 Institute for Child Health
Red Cross Children’s Hospital
Rondebosch, 7700 Cape Town
South Africa
anthony.figaji@uct.ac.za
Jennifer Fugate, DO
Department of Neurology
Mayo Clinic
200 First Street SW
Rochester, MN 55905
Fugate.Jennifer@mayo.edu
Raimund Helbok, MD
Department of Neurology, Neurocritical Care Unit
Innsbruck Medical University
Anichstr.35, 6020
Innsbruck,
Austria
raimund.helbok@uki.at
David Horowitz, MD
Associate Chief Medical Officer
University of Pennsylvania Health System
3701 Market Street
Philadelphia, PA, 19104
USA
david.horowitz@uphs.upenn.edu
Peter Hutchinson, MD
Professor of Neurosurgery
NIHR Research Professor
Department of Clinical Neurosciences
University of Cambridge
Box 167 Addenbrooke’s Hospital
Cambridge CB2 2QQ
United Kingdom
pjah2@cam.ac.uk
Monisha Kumar, MD
Department of Neurology
Perelman School of Medicine, University of Pennsylvania,
3 West Gates
3400 Spruce Street
Philadelphia, PA, 19104
USA
monisha.kumar@uphs.upenn.edu
Molly McNett, RN, PhD
Director, Nursing Research
The MetroHealth System
2500 MetroHealth Drive
Cleveland, OH 44109
USA
mmcnett@metrohealth.org
Chad Miller, MD
Division of Cerebrovascular Diseases and Neurocritical Care
The Ohio State University
395 W. 12th Ave, 7th Floor
Columbus, OH 43210
ChadM.Miller@osumc.edu
Andrew Naidech, MD, MSPH
Department of Neurology
Northwestern University Feinberg SOM 710
N Lake Shore Drive, 11th floor
Chicago, IL 60611
ANaidech@nmff.org
Mauro Oddo, MD
Department of Intensive Care Medicine
CHUV University Hospital, BH 08-623
Faculty of Biology and Medicine University of Lausanne
1011 Lausanne, Switzerland
Mauro.Oddo@chuv.ch
DaiWai Olson, RN, PhD
Associate Professor of Neurology, Neurotherapeutics and Neurosurgery
University of Texas Southwestern
5323 Harry Hines Blvd.
Dallas, TX 75390-8897
USA
daiwai.olson@utsouthwestern.edu
Kristine O’Phelan M.D.
Director of Neurocritical Care
Associate Professor, Department of Neurology
University of Miami, Miller School of Medicine
JMH, 1611 NW 12th Ave, Suite 405
Miami, FL 33136
USA
kophelan@med.miami.edu
Javier Provencio, MD
Associate Professor of Medicine
Cerebrovascular Center and Neuroinflammation Research Center
Lerner College of Medicine
Cleveland Clinic
9500 Euclid Ave, NC30
Cleveland, OH 44195
USA
provenj@ccf.org
Corina Puppo, MD
Assistant Professor, Intensive Care Unit
Hospital de Clinicas, Universidad de la República
Montevideo
Uruguay
coripuppo@gmail.com
Richard Riker, MD
Critical Care Medicine
Maine Medical Center
22 Bramhall Street
Portland, Maine 04102-3175
USA
RRiker@cmamaine.com
Claudia Robertson, MD
Department of Neurosurgery
Medical Director of Center for Neurosurgical Intensive Care,
Ben Taub Hospital
Baylor College of Medicine
1504 Taub Loop, Houston, TX 77030
USA
claudiar@bcm.tmc.edu
J. Michael Schmidt, PhD, MSc
Director of Neuro-ICU Monitoring and Informatics
Columbia University College of Physicians and Surgeons
Milstein Hospital 8 Garden South, Suite 331
177 Fort Washington Avenue
New York, NY 10032
USA
mjs2134@columbia.edu
Fabio Taccone, MD
Department of Intensive Care, Laboratoire de Recherche Experimentale
Erasme Hospital
Route de Lennik, 808
1070 Brussels
Belgium
ftaccone@ulb.ac.be
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Hutchinson, P., O’Phelan, K. & The Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring. International Multidisciplinary Consensus Conference on Multimodality Monitoring: Cerebral Metabolism. Neurocrit Care 21 (Suppl 2), 148–158 (2014). https://doi.org/10.1007/s12028-014-0035-3
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DOI: https://doi.org/10.1007/s12028-014-0035-3