Anzeige
Erschienen in:
01.04.2015 | Original Article
Bedside Evaluation of Cerebral Energy Metabolism in Severe Community-Acquired Bacterial Meningitis
Erschienen in: Neurocritical Care | Ausgabe 2/2015
Einloggen, um Zugang zu erhaltenAbstract
Background
Mortality and morbidity have remained high in bacterial meningitis. Impairment of cerebral energy metabolism probably contributes to unfavorable outcome. Intracerebral microdialysis is routinely used to monitor cerebral energy metabolism, and recent experimental studies indicate that this technique may separate ischemia and non-ischemic mitochondrial dysfunction. The present study is a retrospective interpretation of biochemical data obtained in a series of patients with severe community-acquired meningitis.
Methods
Cerebral energy metabolism was monitored in 15 patients with severe community-acquired meningitis utilizing intracerebral microdialysis and bedside biochemical analysis. According to previous studies, cerebral ischemia was defined as lactate/pyruvate (LP) ratio >30 with intracerebral pyruvate level <70 µmol L−1. Non-ischemic mitochondrial dysfunction was defined as LP-ratio >30 at a normal or increased interstitial concentration of pyruvate (≥70 μmol L−1). Patients with LP-ratios <30 were classified as no mitochondrial dysfunction.
Results
The biochemical pattern was in 8 patients (10 microdialysis catheters) classified as no mitochondrial dysfunction, in 5 patients classified as non-ischemic mitochondrial dysfunction, and in 2 patients (3 catheters) classified as ischemia.
Conclusions
In patients with severe community-acquired meningitis, compromised cerebral energy metabolism occurs frequently and was diagnosed in 7 out of 15 cases. A biochemical pattern of non-ischemic mitochondrial dysfunction appears to be a more common underlying condition than cerebral ischemia.