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The Neurological Wake-up Test Does not Alter Cerebral Energy Metabolism and Oxygenation in Patients with Severe Traumatic Brain Injury
Uppsala Universitet, Institutionen för neurovetenskap, Sweden.ORCID iD: 0000-0001-8008-8169
Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
Uppsala Universitet, Institutionen för neurovetenskap, Sweden.
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2014 (English)In: Neurocritical Care, ISSN 1541-6933, E-ISSN 1556-0961, Neurocritical Care, ISSN 1541-6933, Vol. 2014, no 20, 413-426 p., 3Article in journal (Other academic) Published
Abstract [en]

Background: The neurological wake-up test (NWT) is used to monitor the level of consciousness in patients with traumatic brain injury (TBI). However, it requires interruption of sedation and may elicit a stress response. We evaluated the effects of the NWT using cerebral microdialysis (MD), brain tissue oxygenation (PbtiO2), jugular venous oxygen saturation (SjvO2), and/or arterial-venous difference (AVD) for glucose, lactate, and oxygen in patients with severe TBI.Methods: Seventeen intubated TBI patients (age16–74 years) were sedated using continuous propofol infusion. All patients received intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring in addition to MD, PbtiO2and/or SjvO2 . Up to 10 days postinjury, ICP, CPP, PbtiO2 (51 NWTs), MD (49 NWTs), and/or SjvO2 (18 NWTs) levels during propofol sedation (baseline) and NWT were ompared. MD was evaluated at a flow rate of 1.0 µL/min (28 NWTs) or the routine 0.3 µL/min rate (21 NWTs). Results: The NWT increased ICPandCPP levels (p<0.05). Compared to baseline, nterstitial levels of glucose, lactate, pyruvate, glutamate, glycerol, and the actate/pyruvate ratio were unaltered by the NWT. Pathological SjvO2(<50 % or >71 % ;n=2 NWTs) and PbtiO2(<10 mmHg; n=3 NWTs) values were rare at baseline and did not change following NWT. Finally, the NWT did not alter the AVD of glucose, lactate, or oxygen. Conclusions: The NWT-induced stress response resulted in increased ICP and CPP levels although it did not negatively alter focal neurochemistry or cerebral oygenation in TBI patients.

Place, publisher, year, edition, pages
New York: Springer Science+Business Media B.V., 2014. Vol. 2014, no 20, 413-426 p., 3
Keyword [en]
Traumatic brain injury, intracerebral microdialysis, brain tissue oxygenation, jugular venous oxygenation, neurological wake up test
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:mdh:diva-21969DOI: 10.1007/s12028-013-9876-4PubMedID: 2-s2.0-84902384968Scopus ID: 2-s2.0-84902384968OAI: oai:DiVA.org:mdh-21969DiVA: diva2:656818
Available from: 2012-04-24 Created: 2013-10-17 Last updated: 2015-09-03Bibliographically approved

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