A comparison of cerebrospinal and extracellular fluid in severe traumatic brain injured patients

2.50
Hdl Handle:
http://hdl.handle.net/10755/163708
Category:
Abstract
Type:
Presentation
Title:
A comparison of cerebrospinal and extracellular fluid in severe traumatic brain injured patients
Author(s):
Puccio, Ava; Fischer, Micheal; Wisniewski, Stephen
Author Details:
Ava Puccio, RN, PhD, Assistant Professor of Neurological Surgery & Nursing, Co-Director, Neurotrauma Clinical Trials Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA, email: puccioam@upmc.edu; Micheal Fischer; Stephen Wisniewski
Abstract:
Purpose: The purpose of this study was to compare extracellular fluid (ECF) concentrations of glutamate and lactate/pyruvate (L/P), using in vivo microdialysis, to cerebrospinal fluid (CSF) concentrations early after traumatic brain injury (TBI). Specific Aims: 1. To measure concentrations of glutamate and L/P in ECF and CSF. 2. To correlate ECF and CSF and to examine the relationship, controlling for severity of injury (initial Glasgow Coma Scale Score < 9), using a linear regression model. Framework: In normal individuals, ventricular CSF levels of glutamate and L/P concentrations reflect ECF levels. In TBI patients, glutamate and L/P concentrations are dramatically elevated early after injury in cortex, within and adjacent to contusions. We were interested in comparing CSF to ECF concentrations to determine how well CSF levels would reliably predict ECF levels of these neurochemicals. Methods: In 32 TBI patients (1996-2000), microdialysis probes were surgically placed 12mm into the penumbra region surrounding a contusion, infused with sterile, normal saline at 2 µl/minute, and the dialysate was sampled every 30 minutes. Ventricular CSF samples obtained within 2hrs of obtaining dialysate samples were used for comparison of the neurochemicals. A total of 303 matched samples were analyzed by high pressure liquid chromatography (HPLC) for glutamate (fluorescence detection), and L/P (UV detection). A linear regression model was used to examine the relationship of CSF and ECF concentrations, controlling for severity of injury. Results: ECF levels were markedly increased and more variable than CSF levels, with mean glutamate values: 7.0+/-15.9 µM and 3.4+/-5.4 µM and L/P values: 41.1+/-67.5 and 25.0+/-31.3, respectively. There was a bivariant correlation between CSF and ECF glutamate (r=.13 , p=.047) and L/P (r=.16, p=.0112). The model showed a strong association between CSF and ECF L/P levels (p< .0001): with every 1 unit increase in ECF L/P, CSF L/P increases .05 units. Glutamate levels showed a similar trend, although not as strong (p =.06): with every 1 µM increase in ECF, there was a corresponding increase of .045 µM in CSF. Conclusions: Although microdialysis sampling at the site of injury is ideal, CSF concentrations of glutamate, lactate and pyruvate may be used to monitor ECF levels of secondary injury mediators. Nursing Implications: Many institutions do have the high technology of microdialysis sampling. A simpler way of measuring neurochemicals is by sampling CSF concentrations. These CSF samples can estimate ECF concentrations, with close observations of subtle changes in concentration.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2002
Conference Name:
14th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
University Park, Pennsylvania, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleA comparison of cerebrospinal and extracellular fluid in severe traumatic brain injured patientsen_GB
dc.contributor.authorPuccio, Avaen_US
dc.contributor.authorFischer, Michealen_US
dc.contributor.authorWisniewski, Stephenen_US
dc.author.detailsAva Puccio, RN, PhD, Assistant Professor of Neurological Surgery & Nursing, Co-Director, Neurotrauma Clinical Trials Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA, email: puccioam@upmc.edu; Micheal Fischer; Stephen Wisniewskien_US
dc.identifier.urihttp://hdl.handle.net/10755/163708-
dc.description.abstractPurpose: The purpose of this study was to compare extracellular fluid (ECF) concentrations of glutamate and lactate/pyruvate (L/P), using in vivo microdialysis, to cerebrospinal fluid (CSF) concentrations early after traumatic brain injury (TBI). Specific Aims: 1. To measure concentrations of glutamate and L/P in ECF and CSF. 2. To correlate ECF and CSF and to examine the relationship, controlling for severity of injury (initial Glasgow Coma Scale Score < 9), using a linear regression model. Framework: In normal individuals, ventricular CSF levels of glutamate and L/P concentrations reflect ECF levels. In TBI patients, glutamate and L/P concentrations are dramatically elevated early after injury in cortex, within and adjacent to contusions. We were interested in comparing CSF to ECF concentrations to determine how well CSF levels would reliably predict ECF levels of these neurochemicals. Methods: In 32 TBI patients (1996-2000), microdialysis probes were surgically placed 12mm into the penumbra region surrounding a contusion, infused with sterile, normal saline at 2 &micro;l/minute, and the dialysate was sampled every 30 minutes. Ventricular CSF samples obtained within 2hrs of obtaining dialysate samples were used for comparison of the neurochemicals. A total of 303 matched samples were analyzed by high pressure liquid chromatography (HPLC) for glutamate (fluorescence detection), and L/P (UV detection). A linear regression model was used to examine the relationship of CSF and ECF concentrations, controlling for severity of injury. Results: ECF levels were markedly increased and more variable than CSF levels, with mean glutamate values: 7.0+/-15.9 &micro;M and 3.4+/-5.4 &micro;M and L/P values: 41.1+/-67.5 and 25.0+/-31.3, respectively. There was a bivariant correlation between CSF and ECF glutamate (r=.13 , p=.047) and L/P (r=.16, p=.0112). The model showed a strong association between CSF and ECF L/P levels (p< .0001): with every 1 unit increase in ECF L/P, CSF L/P increases .05 units. Glutamate levels showed a similar trend, although not as strong (p =.06): with every 1 &micro;M increase in ECF, there was a corresponding increase of .045 &micro;M in CSF. Conclusions: Although microdialysis sampling at the site of injury is ideal, CSF concentrations of glutamate, lactate and pyruvate may be used to monitor ECF levels of secondary injury mediators. Nursing Implications: Many institutions do have the high technology of microdialysis sampling. A simpler way of measuring neurochemicals is by sampling CSF concentrations. These CSF samples can estimate ECF concentrations, with close observations of subtle changes in concentration.en_GB
dc.date.available2011-10-27T11:12:26Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:12:26Z-
dc.conference.date2002en_US
dc.conference.name14th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationUniversity Park, Pennsylvania, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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