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Acute brain injury due to aneurysmal subarachnoid haemorrhage (SAH) or traumatic brain injury (TBI) is a condition with a high mortality, and surviving patients often have permanent disabilities. Multimodal neuromonitoring of intracranial pressure, brain tissue oxygen tension (PbtO2), and brain energy metabolism (measured with microdialysis (MD)) may help individualise the treatment of this patient group to protect the brain and potentially improve outcomes. However, there is still a significant lack of knowledge regarding the advantages and disadvantages of this type of monitoring.
The present study consists of four substudies with the overall aim of examining which factors are most influential for regulating commonly measured intracerebral parameters such as oxygenation, glucose, and lactate. Additionally, the influence of these of parameters on functional outcome and mortality will be explored.
The individual studies are detailed below:
Substudy 1:
This study investigates the relationship between glucose in blood and microdialysate (MD-glucose) in patients with severe traumatic brain injury (TBI) or aneurysmal subarachnoid haemorrhage (SAH).
Substudy 2:
The aim of this substudy is to examine the contribution of arterial oxygen tension (PaO2) to PbtO2 in patients with acute brain injury. We hypothesize that there is an association between the two parameters, that this relationship is altered in patients with concurrent intracranial hypoertension, and that a higher burden of cerebral hypoxia is associated with poor functional outcome and mortality.
Substudy 3:
The study aims to estimate the contribution of systemic lactate to microdialysate lactate, hypothesizing that:
Substudy 4:
The study aims to establish whether there is a predictive threshold value of MD-glutamate for unfavourable functional outcome 6 months after ictus of brain injury. Additionally, we aim to explore whether there is a pattern of MD-glutamate that can predict episodes of neuroworsening.
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| Measure | Description | Time Frame |
|---|---|---|
| Correlation between systemic glucose and microdialysis glucose | Median goodness of fit (Pearsons R2) | Throughout the duration of neuromonitoring in the neuro-ICU (1-30 days) |
| Median goodness of fit (Pearsons R2) of the relationship between PaO2 (kPa) and PbtO2 (mmHg). | Median goodness of fit (Pearsons R2) | Throughout the duration of neuromonitoring in the neuro-ICU (1-30 days) |
| Correlation between systemic lactate and microdialysis lactate when corrected for PbtO2 and cerebral perfusion pressure. | Median goodness of fit (Pearsons R2) | Throughout the duration of neuromonitoring in the neuro-ICU (1-30 days) |
| The predictive value of glutamate measured by intracerebral microdialysis for episodes of neuroworsening | Area under the curve | Throughout the duration of neuromonitoring in the neuro-ICU (1-30 days) |
| The predictive value of glutamate measured by intracerebral microdialysis for 6-month functional outcome | Modified Rankin Scale | Throughout the duration of neuromonitoring in the neuro-ICU (1-30 days) |
| Measure | Description | Time Frame |
|---|---|---|
| Length of hospital stay | Time in days | From admission until discharge (1-300 days) |
| Mixed effects linear regression of the relationship betwen PaO2 (kPa) and PbtO2 (mmHg). | mmHg/kPa |
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Inclusion Criteria:
Exclusion Criteria:
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Patients with severe acute brain injury and diagnosis of traumatic brain injury or subarachnoid haemorrhage admitted to the neurointensive care unit at Copenhagen University Hospital Rigshospitalet
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| Name | Affiliation | Role |
|---|---|---|
| Kirsten W Møller | Rigshospitalet, Afdeling for bedøvelse og intensiv behandling | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Rigshospitalet | Copenhagen | 2100 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40528433 | Derived | Fenger AW, Lund A, Vassilieva A, Andreasen TH, Ebdrup SR, Bodilsen TS, Jensen HR, Olsen MH, Moller K. Relationship Between Systemic and Cerebral Microdialysate Glucose in Patients With Severe Acute Brain Injury-A Retrospective Study. Acta Anaesthesiol Scand. 2025 Jul;69(6):e70078. doi: 10.1111/aas.70078. |
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| ID | Term |
|---|---|
| D001930 | Brain Injuries |
| ID | Term |
|---|---|
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D006259 | Craniocerebral Trauma |
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| Six months after admission to the neuro-ICU |
| Functional outcome at six months | Modified Rankin Scale | Six months after admission to the neuro-ICU |
| Mortality at six months | Percent | Six months after admission to the neuro-ICU |
| Length of stay in the ICU | Time in days | From admission until discharge from the ICU (1-300 days) |
| D020196 | Trauma, Nervous System |
| D014947 | Wounds and Injuries |