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Keywords {🔍}

studies, cmd, outcome, google, scholar, brain, pubmed, article, patients, injury, association, evidence, measures, microdialysis, study, tissue, cerebral, severe, traumatic, data, patient, review, grade, care, lpr, tbi, cas, functional, monitoring, elevated, measured, glutamate, reported, low, included, glycerol, neurophysiologic, months, support, analysis, research, systematic, common, imaging, glucose, assessment, outcomes, clinical, based, analytes,

Topics {✒️}

focal intra-cerebral hemorrhage subarachnoid hemorrhage article download pdf time-dependent glutamate-mediated glycolysis icu-based therapies offered/provided cerebral acid-base homeostasis extracellular n-acetylaspartate depletion icp/cpp directed care/therapies subacute/chronic tissue outcomes multi-modal physiologic monitoring cranial access device acute/subacute phase elevation neuro-physiologic variable measured mentioned neuro-physiologic measures prospective single-arm studies selective patho-anatomical groups multi-modal intracranial monitoring multi-modal monitoring parameters delineate injury burden/pattern multi-modal monitoring techniques focal biochemical profiles good clinical/physiologic progression neuro-physiologic measure studies lactate/pyruvate ratio independent neuro-intensive care units fatally head-injured humans full access laser doppler flowmeter cerebral metabolic patterns variable intervals post-tbi acute/subacute hospital stay neuro-intensive-care patients acute/subacute cmd measures published meeting proceedings excitatory amino acids le roux pd biochemical markers analyzed serum glucose levels positron emission tomography tissue outcome/tissue fate cerebral perfusion pressure post-tbi icu care mortality/glasgow outcome scale frontal lobe atrophy patients post-decompressive craniectomy cell breakdown markers guyatt gh /magnetic resonance spectroscopy privacy choices/manage cookies common cmd markers

Questions {❓}

• Are these analytes associated with specific neurophysiologic changes seen during NICU care?
• Are these analytes associated with tissue outcome on imaging (such as acute ischemia/infarct, or atrophy long term)?
• Asgari S, Vespa P, Hu X (2013) Is there any association between cerebral vasoconstriction/vasodilation and microdialysis lactate to pyruvate ratio increase?
• Do commonly measured CMD analytes display an association with patient functional outcome?
• Do commonly measured CMD analytes have an association with neuro-physiologic measures in moderate and severe TBI?
• Do commonly measured CMD analytes have an association with patient functional outcome in moderate and severe TBI?
• Do commonly measured CMD analytes have an association with tissue outcome/tissue fate in moderate and severe TBI?
• Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schünemann HJ, GRADE Working Group (2008) Rating quality of evidence and strength of recommendations: What is "quality of evidence" and why is it important to clinicians?
• Vilalta A, Sahuquillo J, Merino MA, Poca MA, Garnacho A, Martínez-Valverde T, Dronavalli M (2011) Normobaric hyperoxia in traumatic brain injury: does brain metabolic state influence the response to hyperoxic challenge?

Schema {🗺️}

WebPage:
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         headline:A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome
         description:To perform a systematic review on commonly measured cerebral microdialysis (CMD) analytes and their association to: (A) patient functional outcome, (B) neurophysiologic measures, and (C) tissue outcome; after moderate/severe TBI. The aim was to provide a foundation for next-generation CMD studies and build on existing pragmatic expert guidelines for CMD. We searched MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to October 2016). Strength of evidence was adjudicated using GRADE. (A) Functional Outcome: 55 articles were included, assessing outcome as mortality or Glasgow Outcome Scale (GOS) at 3–6 months post-injury. Overall, there is GRADE C evidence to support an association between CMD glucose, glutamate, glycerol, lactate, and LPR to patient outcome at 3–6 months. (B) Neurophysiologic Measures: 59 articles were included. Overall, there currently exists GRADE C level of evidence supporting an association between elevated CMD measured mean LPR, glutamate and glycerol with elevated ICP and/or decreased CPP. In addition, there currently exists GRADE C evidence to support an association between elevated mean lactate:pyruvate ratio (LPR) and low PbtO2. Remaining CMD measures and physiologic outcomes displayed GRADE D or no evidence to support a relationship. (C) Tissue Outcome: four studies were included. Given the conflicting literature, the only conclusion that can be drawn is acute/subacute phase elevation of CMD measured LPR is associated with frontal lobe atrophy at 6 months. This systematic review replicates previously documented relationships between CMD and various outcome, which have driven clinical application of the technique. Evidence assessments do not address the application of CMD for exploring pathophysiology or titrating therapy in individual patients, and do not account for the modulatory effect of therapy on outcome, triggered at different CMD thresholds in individual centers. Our findings support clinical application of CMD and refinement of existing guidelines.
         datePublished:2017-10-07T00:00:00Z
         dateModified:2017-10-07T00:00:00Z
         pageStart:2245
         pageEnd:2273
         sameAs:https://doi.org/10.1007/s00701-017-3338-2
         keywords:
            Cerebral microdialysis
            Systematic review
            Patient outcome
            Functional outcome
            Neurosurgery
            Interventional Radiology
            Neuroradiology
            Neurology
            Surgical Orthopedics
            Minimally Invasive Surgery
         image:
         isPartOf:
            name:Acta Neurochirurgica
            issn:
               0942-0940
               0001-6268
            volumeNumber:159
            type:
               Periodical
               PublicationVolume
         publisher:
            name:Springer Vienna
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         author:
               name:Frederick A. Zeiler
               affiliation:
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                     address:
                        name:Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
                        type:PostalAddress
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                     name:University of Manitoba
                     address:
                        name:Clinician Investigator Program, University of Manitoba, Winnipeg, Canada
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                        name:Department of Anesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
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                     address:
                        name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
                        type:PostalAddress
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                     name:Karolinska Institutet
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                        name:Department of Clinical Neuroscience, Neurosurgical Research Laboratory, Karolinska University Hospital, Building R2:02, Karolinska Institutet, Stockholm, Sweden
                        type:PostalAddress
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                     name:University of Cambridge
                     address:
                        name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
                        type:PostalAddress
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               name:Marek Czosnyka
               affiliation:
                     name:University of Cambridge
                     address:
                        name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
                        type:PostalAddress
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                     name:University of Cambridge
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                        name:Section of Brain Physics, Division of Neurosurgery, University of Cambridge, Cambridge, UK
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               name:Peter J. A. Hutchinson
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                        name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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                        name:Queens’ College, Cambridge, UK
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                        name:National Institute for Health Research, Southampton, UK
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      context:https://schema.org
ScholarlyArticle:
      headline:A systematic review of cerebral microdialysis and outcomes in TBI: relationships to patient functional outcome, neurophysiologic measures, and tissue outcome
      description:To perform a systematic review on commonly measured cerebral microdialysis (CMD) analytes and their association to: (A) patient functional outcome, (B) neurophysiologic measures, and (C) tissue outcome; after moderate/severe TBI. The aim was to provide a foundation for next-generation CMD studies and build on existing pragmatic expert guidelines for CMD. We searched MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library (inception to October 2016). Strength of evidence was adjudicated using GRADE. (A) Functional Outcome: 55 articles were included, assessing outcome as mortality or Glasgow Outcome Scale (GOS) at 3–6 months post-injury. Overall, there is GRADE C evidence to support an association between CMD glucose, glutamate, glycerol, lactate, and LPR to patient outcome at 3–6 months. (B) Neurophysiologic Measures: 59 articles were included. Overall, there currently exists GRADE C level of evidence supporting an association between elevated CMD measured mean LPR, glutamate and glycerol with elevated ICP and/or decreased CPP. In addition, there currently exists GRADE C evidence to support an association between elevated mean lactate:pyruvate ratio (LPR) and low PbtO2. Remaining CMD measures and physiologic outcomes displayed GRADE D or no evidence to support a relationship. (C) Tissue Outcome: four studies were included. Given the conflicting literature, the only conclusion that can be drawn is acute/subacute phase elevation of CMD measured LPR is associated with frontal lobe atrophy at 6 months. This systematic review replicates previously documented relationships between CMD and various outcome, which have driven clinical application of the technique. Evidence assessments do not address the application of CMD for exploring pathophysiology or titrating therapy in individual patients, and do not account for the modulatory effect of therapy on outcome, triggered at different CMD thresholds in individual centers. Our findings support clinical application of CMD and refinement of existing guidelines.
      datePublished:2017-10-07T00:00:00Z
      dateModified:2017-10-07T00:00:00Z
      pageStart:2245
      pageEnd:2273
      sameAs:https://doi.org/10.1007/s00701-017-3338-2
      keywords:
         Cerebral microdialysis
         Systematic review
         Patient outcome
         Functional outcome
         Neurosurgery
         Interventional Radiology
         Neuroradiology
         Neurology
         Surgical Orthopedics
         Minimally Invasive Surgery
      image:
      isPartOf:
         name:Acta Neurochirurgica
         issn:
            0942-0940
            0001-6268
         volumeNumber:159
         type:
            Periodical
            PublicationVolume
      publisher:
         name:Springer Vienna
         logo:
            url:https://www.springernature.com/app-sn/public/images/logo-springernature.png
            type:ImageObject
         type:Organization
      author:
            name:Frederick A. Zeiler
            affiliation:
                  name:University of Manitoba
                  address:
                     name:Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
                     type:PostalAddress
                  type:Organization
                  name:University of Manitoba
                  address:
                     name:Clinician Investigator Program, University of Manitoba, Winnipeg, Canada
                     type:PostalAddress
                  type:Organization
                  name:University of Cambridge
                  address:
                     name:Department of Anesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
                     type:PostalAddress
                  type:Organization
            email:[email protected]
            type:Person
            name:Eric Peter Thelin
            affiliation:
                  name:University of Cambridge
                  address:
                     name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
                     type:PostalAddress
                  type:Organization
                  name:Karolinska Institutet
                  address:
                     name:Department of Clinical Neuroscience, Neurosurgical Research Laboratory, Karolinska University Hospital, Building R2:02, Karolinska Institutet, Stockholm, Sweden
                     type:PostalAddress
                  type:Organization
            type:Person
            name:Adel Helmy
            affiliation:
                  name:University of Cambridge
                  address:
                     name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
                     type:PostalAddress
                  type:Organization
            type:Person
            name:Marek Czosnyka
            affiliation:
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                  address:
                     name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
                     type:PostalAddress
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                  address:
                     name:Section of Brain Physics, Division of Neurosurgery, University of Cambridge, Cambridge, UK
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            name:Peter J. A. Hutchinson
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                     type:PostalAddress
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      name:University of Cambridge
      address:
         name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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      address:
         name:Department of Clinical Neuroscience, Neurosurgical Research Laboratory, Karolinska University Hospital, Building R2:02, Karolinska Institutet, Stockholm, Sweden
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      address:
         name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
         type:PostalAddress
      name:University of Cambridge
      address:
         name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
         type:PostalAddress
      name:University of Cambridge
      address:
         name:Section of Brain Physics, Division of Neurosurgery, University of Cambridge, Cambridge, UK
         type:PostalAddress
      name:University of Cambridge
      address:
         name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
         type:PostalAddress
      name:University of Cambridge
      address:
         name:Department of Anesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
         type:PostalAddress
      name:Addenbrooke’s Hospital
      address:
         name:Neurosciences Critical Care Unit, Addenbrooke’s Hospital, Cambridge, UK
         type:PostalAddress
      name:Queens’ College
      address:
         name:Queens’ College, Cambridge, UK
         type:PostalAddress
      name:National Institute for Health Research
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         name:National Institute for Health Research, Southampton, UK
         type:PostalAddress
ImageObject:
      url:https://www.springernature.com/app-sn/public/images/logo-springernature.png
Person:
      name:Frederick A. Zeiler
      affiliation:
            name:University of Manitoba
            address:
               name:Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
               type:PostalAddress
            type:Organization
            name:University of Manitoba
            address:
               name:Clinician Investigator Program, University of Manitoba, Winnipeg, Canada
               type:PostalAddress
            type:Organization
            name:University of Cambridge
            address:
               name:Department of Anesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
               type:PostalAddress
            type:Organization
      email:[email protected]
      name:Eric Peter Thelin
      affiliation:
            name:University of Cambridge
            address:
               name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
               type:PostalAddress
            type:Organization
            name:Karolinska Institutet
            address:
               name:Department of Clinical Neuroscience, Neurosurgical Research Laboratory, Karolinska University Hospital, Building R2:02, Karolinska Institutet, Stockholm, Sweden
               type:PostalAddress
            type:Organization
      name:Adel Helmy
      affiliation:
            name:University of Cambridge
            address:
               name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
               type:PostalAddress
            type:Organization
      name:Marek Czosnyka
      affiliation:
            name:University of Cambridge
            address:
               name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
               type:PostalAddress
            type:Organization
            name:University of Cambridge
            address:
               name:Section of Brain Physics, Division of Neurosurgery, University of Cambridge, Cambridge, UK
               type:PostalAddress
            type:Organization
      name:Peter J. A. Hutchinson
      affiliation:
            name:University of Cambridge
            address:
               name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
               type:PostalAddress
            type:Organization
      name:David K. Menon
      affiliation:
            name:University of Cambridge
            address:
               name:Department of Anesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
               type:PostalAddress
            type:Organization
            name:Addenbrooke’s Hospital
            address:
               name:Neurosciences Critical Care Unit, Addenbrooke’s Hospital, Cambridge, UK
               type:PostalAddress
            type:Organization
            name:Queens’ College
            address:
               name:Queens’ College, Cambridge, UK
               type:PostalAddress
            type:Organization
            name:National Institute for Health Research
            address:
               name:National Institute for Health Research, Southampton, UK
               type:PostalAddress
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PostalAddress:
      name:Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
      name:Clinician Investigator Program, University of Manitoba, Winnipeg, Canada
      name:Department of Anesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
      name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
      name:Department of Clinical Neuroscience, Neurosurgical Research Laboratory, Karolinska University Hospital, Building R2:02, Karolinska Institutet, Stockholm, Sweden
      name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
      name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
      name:Section of Brain Physics, Division of Neurosurgery, University of Cambridge, Cambridge, UK
      name:Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
      name:Department of Anesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
      name:Neurosciences Critical Care Unit, Addenbrooke’s Hospital, Cambridge, UK
      name:Queens’ College, Cambridge, UK
      name:National Institute for Health Research, Southampton, UK

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