Patterns of cerebral tissue oxygen tension and cytoplasmic redox state in bacterial meningitis

Lykke Larsen; Troels H. Nielsen; Carl-henrik Nordström; Aase B. Andersen; Jens Schierbeck; Mette K. Schulz; Frantz R. Poulsen

doi:10.1111/aas.2019.63.issue-3

Patterns of cerebral tissue oxygen tension and cytoplasmic redox state in bacterial meningitis

Lykke Larsen, Troels H. Nielsen, Carl-henrik Nordström, Aase B. Andersen, Jens Schierbeck, Mette K. Schulz, Frantz R. Poulsen

Institut for Klinisk Medicin

2 Citationer (Scopus)

Abstract

Background: Compromised cerebral energy metabolism is common in patients with bacterial meningitis. In this study, simultaneous measurements of cerebral oxygen tension and lactate/pyruvate ratio were compared to explore whether disturbed energy metabolism was usually caused by insufficient tissue oxygenation or compromised oxidative metabolism of pyruvate indicating mitochondrial dysfunction. Subject and Methods: Ten consecutive patients with severe streptococcus meningitis were included in this prospective cohort study. Intracranial pressure, brain tissue oxygen tension (PbtO ₂ ), and energy metabolism (intracerebral microdialysis) were continuously monitored in nine patients. A cerebral lactate/pyruvate (LP) ratio <30 was considered indicating normal oxidative metabolism, LP ratio >30 simultaneously with pyruvate below lower normal level (70 µmol/L) was interpreted as biochemical indication of ischemia, and LP ratio >30 simultaneously with a normal or increased level of pyruvate was interpreted as mitochondrial dysfunction. The biochemical variables were compared with PbtO ₂ simultaneously monitored within the same cerebral region. Results: In two cases, the LP ratio was normal during the whole study period and the simultaneously monitored PbtO ₂ was 18 ± 6 mm Hg. In six cases, interpreted as mitochondrial dysfunction, the simultaneously monitored PbtO ₂ was 20 ± 6 mm Hg and without correlation with the LP ratio. In one patient, exhibiting a pattern interpreted as ischemia, PbtO ₂ decreased below 10 mm Hg and a correlation between LP and PbtO ₂ was observed. Conclusion: This study demonstrated that compromised cerebral energy metabolism, evidenced by increased LP ratio, was common in patients with severe bacterial meningitis while not related to insufficient tissue oxygenation.

Originalsprog	Engelsk
Bogserie	Acta Anaesthesiologica Scandinavica
Vol/bind	63
Udgave nummer	3
Sider (fra-til)	329-336
ISSN	0001-5172
DOI	https://doi.org/10.1111/aas.2019.63.issue-3
Status	Udgivet - mar. 2019

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10.1111/aas.2019.63.issue-3

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@article{b324ad20f23f45ddb25c22e1dc747b74,

title = "Patterns of cerebral tissue oxygen tension and cytoplasmic redox state in bacterial meningitis",

abstract = " Background: Compromised cerebral energy metabolism is common in patients with bacterial meningitis. In this study, simultaneous measurements of cerebral oxygen tension and lactate/pyruvate ratio were compared to explore whether disturbed energy metabolism was usually caused by insufficient tissue oxygenation or compromised oxidative metabolism of pyruvate indicating mitochondrial dysfunction. Subject and Methods: Ten consecutive patients with severe streptococcus meningitis were included in this prospective cohort study. Intracranial pressure, brain tissue oxygen tension (PbtO 2 ), and energy metabolism (intracerebral microdialysis) were continuously monitored in nine patients. A cerebral lactate/pyruvate (LP) ratio <30 was considered indicating normal oxidative metabolism, LP ratio >30 simultaneously with pyruvate below lower normal level (70 µmol/L) was interpreted as biochemical indication of ischemia, and LP ratio >30 simultaneously with a normal or increased level of pyruvate was interpreted as mitochondrial dysfunction. The biochemical variables were compared with PbtO 2 simultaneously monitored within the same cerebral region. Results: In two cases, the LP ratio was normal during the whole study period and the simultaneously monitored PbtO 2 was 18 ± 6 mm Hg. In six cases, interpreted as mitochondrial dysfunction, the simultaneously monitored PbtO 2 was 20 ± 6 mm Hg and without correlation with the LP ratio. In one patient, exhibiting a pattern interpreted as ischemia, PbtO 2 decreased below 10 mm Hg and a correlation between LP and PbtO 2 was observed. Conclusion: This study demonstrated that compromised cerebral energy metabolism, evidenced by increased LP ratio, was common in patients with severe bacterial meningitis while not related to insufficient tissue oxygenation. ",

author = "Lykke Larsen and Nielsen, {Troels H.} and Carl-henrik Nordstr{\"o}m and Andersen, {Aase B.} and Jens Schierbeck and Schulz, {Mette K.} and Poulsen, {Frantz R.}",

year = "2019",

month = mar,

doi = "10.1111/aas.2019.63.issue-3",

language = "English",

volume = "63",

pages = "329--336",

journal = "Acta Anaesthesiologica Scandinavica, Supplement",

issn = "0515-2720",

publisher = "Wiley-Blackwell",

number = "3",

}

TY - JOUR

T1 - Patterns of cerebral tissue oxygen tension and cytoplasmic redox state in bacterial meningitis

AU - Larsen, Lykke

AU - Nielsen, Troels H.

AU - Nordström, Carl-henrik

AU - Andersen, Aase B.

AU - Schierbeck, Jens

AU - Schulz, Mette K.

AU - Poulsen, Frantz R.

PY - 2019/3

Y1 - 2019/3

N2 - Background: Compromised cerebral energy metabolism is common in patients with bacterial meningitis. In this study, simultaneous measurements of cerebral oxygen tension and lactate/pyruvate ratio were compared to explore whether disturbed energy metabolism was usually caused by insufficient tissue oxygenation or compromised oxidative metabolism of pyruvate indicating mitochondrial dysfunction. Subject and Methods: Ten consecutive patients with severe streptococcus meningitis were included in this prospective cohort study. Intracranial pressure, brain tissue oxygen tension (PbtO 2 ), and energy metabolism (intracerebral microdialysis) were continuously monitored in nine patients. A cerebral lactate/pyruvate (LP) ratio <30 was considered indicating normal oxidative metabolism, LP ratio >30 simultaneously with pyruvate below lower normal level (70 µmol/L) was interpreted as biochemical indication of ischemia, and LP ratio >30 simultaneously with a normal or increased level of pyruvate was interpreted as mitochondrial dysfunction. The biochemical variables were compared with PbtO 2 simultaneously monitored within the same cerebral region. Results: In two cases, the LP ratio was normal during the whole study period and the simultaneously monitored PbtO 2 was 18 ± 6 mm Hg. In six cases, interpreted as mitochondrial dysfunction, the simultaneously monitored PbtO 2 was 20 ± 6 mm Hg and without correlation with the LP ratio. In one patient, exhibiting a pattern interpreted as ischemia, PbtO 2 decreased below 10 mm Hg and a correlation between LP and PbtO 2 was observed. Conclusion: This study demonstrated that compromised cerebral energy metabolism, evidenced by increased LP ratio, was common in patients with severe bacterial meningitis while not related to insufficient tissue oxygenation.

AB - Background: Compromised cerebral energy metabolism is common in patients with bacterial meningitis. In this study, simultaneous measurements of cerebral oxygen tension and lactate/pyruvate ratio were compared to explore whether disturbed energy metabolism was usually caused by insufficient tissue oxygenation or compromised oxidative metabolism of pyruvate indicating mitochondrial dysfunction. Subject and Methods: Ten consecutive patients with severe streptococcus meningitis were included in this prospective cohort study. Intracranial pressure, brain tissue oxygen tension (PbtO 2 ), and energy metabolism (intracerebral microdialysis) were continuously monitored in nine patients. A cerebral lactate/pyruvate (LP) ratio <30 was considered indicating normal oxidative metabolism, LP ratio >30 simultaneously with pyruvate below lower normal level (70 µmol/L) was interpreted as biochemical indication of ischemia, and LP ratio >30 simultaneously with a normal or increased level of pyruvate was interpreted as mitochondrial dysfunction. The biochemical variables were compared with PbtO 2 simultaneously monitored within the same cerebral region. Results: In two cases, the LP ratio was normal during the whole study period and the simultaneously monitored PbtO 2 was 18 ± 6 mm Hg. In six cases, interpreted as mitochondrial dysfunction, the simultaneously monitored PbtO 2 was 20 ± 6 mm Hg and without correlation with the LP ratio. In one patient, exhibiting a pattern interpreted as ischemia, PbtO 2 decreased below 10 mm Hg and a correlation between LP and PbtO 2 was observed. Conclusion: This study demonstrated that compromised cerebral energy metabolism, evidenced by increased LP ratio, was common in patients with severe bacterial meningitis while not related to insufficient tissue oxygenation.

U2 - 10.1111/aas.2019.63.issue-3

DO - 10.1111/aas.2019.63.issue-3

M3 - Journal article

SN - 0515-2720

VL - 63

SP - 329

EP - 336

JO - Acta Anaesthesiologica Scandinavica, Supplement

JF - Acta Anaesthesiologica Scandinavica, Supplement

IS - 3

ER -

Patterns of cerebral tissue oxygen tension and cytoplasmic redox state in bacterial meningitis

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