Metabolic crisis in severely head-injured patients: is ischemia just the tip of the iceberg?
Ischemia and metabolic crisis are frequent post-traumatic secondary brain insults that negatively influence outcome. Clinicians commonly mix up these two types of insults, mainly because high lactate/pyruvate ratio (LPR) is the common marker for both ischemia and metabolic crisis. However, LPR eleva...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2013-10-01
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| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | http://journal.frontiersin.org/Journal/10.3389/fneur.2013.00146/full |
| _version_ | 1819074510583758848 |
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| author | Emilie eCarre Michael eOgier Henry eBoret Ambroise eMontcriol Lionel eBourdon Jean-Jacques eRisso |
| author_facet | Emilie eCarre Michael eOgier Henry eBoret Ambroise eMontcriol Lionel eBourdon Jean-Jacques eRisso |
| author_sort | Emilie eCarre |
| collection | DOAJ |
| description | Ischemia and metabolic crisis are frequent post-traumatic secondary brain insults that negatively influence outcome. Clinicians commonly mix up these two types of insults, mainly because high lactate/pyruvate ratio (LPR) is the common marker for both ischemia and metabolic crisis. However, LPR elevations during ischemia and metabolic crisis reflect two different energetic imbalances: ischemia (Type 1 LPR elevations with low oxygenation) is characterized by a drastic deprivation of energetic substrates, whereas metabolic crisis (Type 2 LPR elevations with normal or high oxygenation) is associated with profound mitochondrial dysfunction but normal supply of energetic substrates. The discrimination between ischemia and metabolic crisis is crucial because conventional recommendations against ischemia may be detrimental for patients with metabolic crisis. Multimodal monitoring, including microdialysis and brain tissue oxygen monitoring, allows such discrimination, but these techniques are not easily accessible to all head-injured patients. Thus, a new gold standard and adapted medical education are required to optimize the management of patients with metabolic crisis. |
| first_indexed | 2024-12-21T18:10:40Z |
| format | Article |
| id | doaj.art-969f236d578949529f2342b5b306ae99 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-21T18:10:40Z |
| publishDate | 2013-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-969f236d578949529f2342b5b306ae992022-12-21T18:54:48ZengFrontiers Media S.A.Frontiers in Neurology1664-22952013-10-01410.3389/fneur.2013.0014648834Metabolic crisis in severely head-injured patients: is ischemia just the tip of the iceberg?Emilie eCarre0Michael eOgier1Henry eBoret2Ambroise eMontcriol3Lionel eBourdon4Jean-Jacques eRisso5Institut de Recherche Biomedicale des ArmeesInstitut de Recherche Biomedicale des ArmeesHopital d'Instruction des Armees Sainte-AnneHopital d'Instruction des Armees Sainte-AnneInstitut de Recherche Biomedicale des ArmeesInstitut de Recherche Biomedicale des ArmeesIschemia and metabolic crisis are frequent post-traumatic secondary brain insults that negatively influence outcome. Clinicians commonly mix up these two types of insults, mainly because high lactate/pyruvate ratio (LPR) is the common marker for both ischemia and metabolic crisis. However, LPR elevations during ischemia and metabolic crisis reflect two different energetic imbalances: ischemia (Type 1 LPR elevations with low oxygenation) is characterized by a drastic deprivation of energetic substrates, whereas metabolic crisis (Type 2 LPR elevations with normal or high oxygenation) is associated with profound mitochondrial dysfunction but normal supply of energetic substrates. The discrimination between ischemia and metabolic crisis is crucial because conventional recommendations against ischemia may be detrimental for patients with metabolic crisis. Multimodal monitoring, including microdialysis and brain tissue oxygen monitoring, allows such discrimination, but these techniques are not easily accessible to all head-injured patients. Thus, a new gold standard and adapted medical education are required to optimize the management of patients with metabolic crisis.http://journal.frontiersin.org/Journal/10.3389/fneur.2013.00146/fullIschemiaintracerebral microdialysisHead injurymetabolic crisismultimodal monitoringbrain tissue oxygen |
| spellingShingle | Emilie eCarre Michael eOgier Henry eBoret Ambroise eMontcriol Lionel eBourdon Jean-Jacques eRisso Metabolic crisis in severely head-injured patients: is ischemia just the tip of the iceberg? Frontiers in Neurology Ischemia intracerebral microdialysis Head injury metabolic crisis multimodal monitoring brain tissue oxygen |
| title | Metabolic crisis in severely head-injured patients: is ischemia just the tip of the iceberg? |
| title_full | Metabolic crisis in severely head-injured patients: is ischemia just the tip of the iceberg? |
| title_fullStr | Metabolic crisis in severely head-injured patients: is ischemia just the tip of the iceberg? |
| title_full_unstemmed | Metabolic crisis in severely head-injured patients: is ischemia just the tip of the iceberg? |
| title_short | Metabolic crisis in severely head-injured patients: is ischemia just the tip of the iceberg? |
| title_sort | metabolic crisis in severely head injured patients is ischemia just the tip of the iceberg |
| topic | Ischemia intracerebral microdialysis Head injury metabolic crisis multimodal monitoring brain tissue oxygen |
| url | http://journal.frontiersin.org/Journal/10.3389/fneur.2013.00146/full |
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