Skip to main content
Top
Published in: Intensive Care Medicine 9/2015

Open Access 01-09-2015 | Conference Reports and Expert Panel

Consensus statement from the 2014 International Microdialysis Forum

Authors: Peter J. Hutchinson, Ibrahim Jalloh, Adel Helmy, Keri L. H. Carpenter, Elham Rostami, Bo-Michael Bellander, Martyn G. Boutelle, Jeff W. Chen, Jan Claassen, Claire Dahyot-Fizelier, Per Enblad, Clare N. Gallagher, Raimund Helbok, Lars Hillered, Peter D. Le Roux, Sandra Magnoni, Halinder S. Mangat, David K. Menon, Carl-Henrik Nordström, Kristine H. O’Phelan, Mauro Oddo, Jon Perez Barcena, Claudia Robertson, Elisabeth Ronne-Engström, Juan Sahuquillo, Martin Smith, Nino Stocchetti, Antonio Belli, T. Adrian Carpenter, Jonathan P. Coles, Marek Czosnyka, Nil Dizdar, J. Clay Goodman, Arun K. Gupta, Troels H. Nielsen, Niklas Marklund, Ambroise Montcriol, Mark T. O’Connell, Maria A. Poca, Asita Sarrafzadeh, Richard J. Shannon, Jane Skjøth-Rasmussen, Peter Smielewski, John F. Stover, Ivan Timofeev, Paul Vespa, Elizabeth Zavala, Urban Ungerstedt

Published in: Intensive Care Medicine | Issue 9/2015

Login to get access

Abstract

Microdialysis enables the chemistry of the extracellular interstitial space to be monitored. Use of this technique in patients with acute brain injury has increased our understanding of the pathophysiology of several acute neurological disorders. In 2004, a consensus document on the clinical application of cerebral microdialysis was published. Since then, there have been significant advances in the clinical use of microdialysis in neurocritical care. The objective of this review is to report on the International Microdialysis Forum held in Cambridge, UK, in April 2014 and to produce a revised and updated consensus statement about its clinical use including technique, data interpretation, relationship with outcome, role in guiding therapy in neurocritical care and research applications.
Appendix
Available only for authorised users
Literature
1.
go back to reference Ungerstedt U, Pycock C (1974) Functional correlates of dopamine neurotransmission. Bull Schweiz Akad Med Wiss 30:44–55PubMed Ungerstedt U, Pycock C (1974) Functional correlates of dopamine neurotransmission. Bull Schweiz Akad Med Wiss 30:44–55PubMed
5.
go back to reference Hutchinson P, O’Phelan K, The Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring (2014) International multidisciplinary consensus conference on multimodality monitoring: cerebral metabolism. Neurocrit Care 21:1–11. doi:10.1007/s12028-014-0035-3 CrossRef Hutchinson P, O’Phelan K, The Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring (2014) International multidisciplinary consensus conference on multimodality monitoring: cerebral metabolism. Neurocrit Care 21:1–11. doi:10.​1007/​s12028-014-0035-3 CrossRef
15.
go back to reference Helmy A, Carpenter KLH, Skepper JN et al (2009) Microdialysis of cytokines: methodological considerations, scanning electron microscopy, and determination of relative recovery. J Neurotrauma 26:549–561. doi:10.1089/neu.2008.0719 PubMedCrossRef Helmy A, Carpenter KLH, Skepper JN et al (2009) Microdialysis of cytokines: methodological considerations, scanning electron microscopy, and determination of relative recovery. J Neurotrauma 26:549–561. doi:10.​1089/​neu.​2008.​0719 PubMedCrossRef
18.
go back to reference Dahlin AP, Wetterhall M, Caldwell KD et al (2010) Methodological aspects on microdialysis protein sampling and quantification in biological fluids: an in vitro study on human ventricular CSF. Anal Chem 82:4376–4385. doi:10.1021/ac1007706 PubMedCrossRef Dahlin AP, Wetterhall M, Caldwell KD et al (2010) Methodological aspects on microdialysis protein sampling and quantification in biological fluids: an in vitro study on human ventricular CSF. Anal Chem 82:4376–4385. doi:10.​1021/​ac1007706 PubMedCrossRef
19.
go back to reference Dahlin AP, Purins K, Clausen F et al (2014) Refined microdialysis method for protein biomarker sampling in acute brain injury in the neurointensive care setting. Anal Chem 86:8671–8679. doi:10.1021/ac501880u PubMedCrossRef Dahlin AP, Purins K, Clausen F et al (2014) Refined microdialysis method for protein biomarker sampling in acute brain injury in the neurointensive care setting. Anal Chem 86:8671–8679. doi:10.​1021/​ac501880u PubMedCrossRef
24.
go back to reference Bhatia R, Hashemi P, Razzaq A et al (2006) Application of rapid-sampling, online microdialysis to the monitoring of brain metabolism during aneurysm surgery. Neurosurgery 58:ONS–313–20. doi:10.1227/01.NEU.0000208963.42378.83 (discussion ONS–321) Bhatia R, Hashemi P, Razzaq A et al (2006) Application of rapid-sampling, online microdialysis to the monitoring of brain metabolism during aneurysm surgery. Neurosurgery 58:ONS–313–20. doi:10.​1227/​01.​NEU.​0000208963.​42378.​83 (discussion ONS–321)
25.
go back to reference Skoglund K, Hillered L, Purins K, Tsitsopoulos PP (2014) The neurological wake-up test does not alter cerebral energy metabolism and oxygenation in patients with severe traumatic brain injury. Neurocrit Care. doi:10.1007/s12028-013-9876-4 PubMed Skoglund K, Hillered L, Purins K, Tsitsopoulos PP (2014) The neurological wake-up test does not alter cerebral energy metabolism and oxygenation in patients with severe traumatic brain injury. Neurocrit Care. doi:10.​1007/​s12028-013-9876-4 PubMed
27.
28.
go back to reference Skjøth-Rasmussen J, Schulz M, Kristensen SR, Bjerre P (2004) Delayed neurological deficits detected by an ischemic pattern in the extracellular cerebral metabolites in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 100:8–15. doi:10.3171/jns.2004.100.1.0008 PubMedCrossRef Skjøth-Rasmussen J, Schulz M, Kristensen SR, Bjerre P (2004) Delayed neurological deficits detected by an ischemic pattern in the extracellular cerebral metabolites in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 100:8–15. doi:10.​3171/​jns.​2004.​100.​1.​0008 PubMedCrossRef
30.
go back to reference Kett-White R, Hutchinson PJ, Al-Rawi PG et al (2002) Cerebral oxygen and microdialysis monitoring during aneurysm surgery: effects of blood pressure, cerebrospinal fluid drainage, and temporary clipping on infarction. J Neurosurg 96:1013–1019. doi:10.3171/jns.2002.96.6.1013 PubMedCrossRef Kett-White R, Hutchinson PJ, Al-Rawi PG et al (2002) Cerebral oxygen and microdialysis monitoring during aneurysm surgery: effects of blood pressure, cerebrospinal fluid drainage, and temporary clipping on infarction. J Neurosurg 96:1013–1019. doi:10.​3171/​jns.​2002.​96.​6.​1013 PubMedCrossRef
33.
34.
go back to reference Hutchinson PJ, Gupta AK, Fryer TF et al (2002) Correlation between cerebral blood flow, substrate delivery, and metabolism in head injury: a combined microdialysis and triple oxygen positron emission tomography study. J Cereb Blood Flow Metab 22:735–745. doi:10.1097/00004647-200206000-00012 PubMedCrossRef Hutchinson PJ, Gupta AK, Fryer TF et al (2002) Correlation between cerebral blood flow, substrate delivery, and metabolism in head injury: a combined microdialysis and triple oxygen positron emission tomography study. J Cereb Blood Flow Metab 22:735–745. doi:10.​1097/​00004647-200206000-00012 PubMedCrossRef
35.
go back to reference Hillered L, Valtysson J, Enblad P, Persson L (1998) Interstitial glycerol as a marker for membrane phospholipid degradation in the acutely injured human brain. J Neurol Neurosurg Psychiatry 64:486–491PubMedCentralPubMedCrossRef Hillered L, Valtysson J, Enblad P, Persson L (1998) Interstitial glycerol as a marker for membrane phospholipid degradation in the acutely injured human brain. J Neurol Neurosurg Psychiatry 64:486–491PubMedCentralPubMedCrossRef
38.
go back to reference Agren-Wilsson A, Roslin M, Eklund A et al (2003) Intracerebral microdialysis and CSF hydrodynamics in idiopathic adult hydrocephalus syndrome. J Neurol Neurosurg Psychiatry 74:217–221PubMedCentralPubMedCrossRef Agren-Wilsson A, Roslin M, Eklund A et al (2003) Intracerebral microdialysis and CSF hydrodynamics in idiopathic adult hydrocephalus syndrome. J Neurol Neurosurg Psychiatry 74:217–221PubMedCentralPubMedCrossRef
39.
go back to reference Eide PK, Stanisic M (2010) Cerebral microdialysis and intracranial pressure monitoring in patients with idiopathic normal-pressure hydrocephalus: association with clinical response to extended lumbar drainage and shunt surgery. J Neurosurg 112:414–424. doi:10.3171/2009.5.09122 PubMedCrossRef Eide PK, Stanisic M (2010) Cerebral microdialysis and intracranial pressure monitoring in patients with idiopathic normal-pressure hydrocephalus: association with clinical response to extended lumbar drainage and shunt surgery. J Neurosurg 112:414–424. doi:10.​3171/​2009.​5.​09122 PubMedCrossRef
40.
go back to reference Zauner A, Doppenberg EM, Woodward JJ et al (1997) Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries. Neurosurgery 41:1082–1091. doi:10.1097/00006123-199711000-00011 (discussion 1091–1093) PubMedCrossRef Zauner A, Doppenberg EM, Woodward JJ et al (1997) Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries. Neurosurgery 41:1082–1091. doi:10.​1097/​00006123-199711000-00011 (discussion 1091–1093) PubMedCrossRef
42.
46.
go back to reference Elf K, Nilsson P, Enblad P (2002) Outcome after traumatic brain injury improved by an organized secondary insult program and standardized neurointensive care. Crit Care Med 30:2129PubMedCrossRef Elf K, Nilsson P, Enblad P (2002) Outcome after traumatic brain injury improved by an organized secondary insult program and standardized neurointensive care. Crit Care Med 30:2129PubMedCrossRef
47.
go back to reference Ståhl N, Mellergård P, Hallström A et al (2001) Intracerebral microdialysis and bedside biochemical analysis in patients with fatal traumatic brain lesions. Acta Anaesthesiol Scand 45:977–985PubMedCrossRef Ståhl N, Mellergård P, Hallström A et al (2001) Intracerebral microdialysis and bedside biochemical analysis in patients with fatal traumatic brain lesions. Acta Anaesthesiol Scand 45:977–985PubMedCrossRef
51.
55.
57.
go back to reference Dizdarevic K, Hamdan A, Omerhodzic I, Kominlija-Smajic E (2012) Modified Lund concept versus cerebral perfusion pressure-targeted therapy: a randomised controlled study in patients with secondary brain ischaemia. Clin Neurol Neurosurg 114:142–148. doi:10.1016/j.clineuro.2011.10.005 PubMedCrossRef Dizdarevic K, Hamdan A, Omerhodzic I, Kominlija-Smajic E (2012) Modified Lund concept versus cerebral perfusion pressure-targeted therapy: a randomised controlled study in patients with secondary brain ischaemia. Clin Neurol Neurosurg 114:142–148. doi:10.​1016/​j.​clineuro.​2011.​10.​005 PubMedCrossRef
58.
go back to reference Cesarini KG, Enblad P, Ronne-Engström E et al (2002) early cerebral hyperglycolysis after subarachnoid haemorrhage correlates with favourable outcome. Acta Neurochir (Wien) 144:1121–1131. doi:10.1007/s00701-002-1011-9 CrossRef Cesarini KG, Enblad P, Ronne-Engström E et al (2002) early cerebral hyperglycolysis after subarachnoid haemorrhage correlates with favourable outcome. Acta Neurochir (Wien) 144:1121–1131. doi:10.​1007/​s00701-002-1011-9 CrossRef
64.
go back to reference Magnoni S, Tedesco C, Carbonara M et al (2012) Relationship between systemic glucose and cerebral glucose is preserved in patients with severe traumatic brain injury, but glucose delivery to the brain may become limited when oxidative metabolism is impaired: implications for glycemic control. Crit Care Med 40:1785–1791. doi:10.1097/CCM.0b013e318246bd45 PubMedCrossRef Magnoni S, Tedesco C, Carbonara M et al (2012) Relationship between systemic glucose and cerebral glucose is preserved in patients with severe traumatic brain injury, but glucose delivery to the brain may become limited when oxidative metabolism is impaired: implications for glycemic control. Crit Care Med 40:1785–1791. doi:10.​1097/​CCM.​0b013e318246bd45​ PubMedCrossRef
66.
go back to reference Parkin M, Hopwood S, Jones DA et al (2005) Dynamic changes in brain glucose and lactate in pericontusional areas of the human cerebral cortex, monitored with rapid sampling on-line microdialysis: relationship with depolarisation-like events. J Cereb Blood Flow Metab 25:402–413. doi:10.1038/sj.jcbfm.9600051 PubMedCrossRef Parkin M, Hopwood S, Jones DA et al (2005) Dynamic changes in brain glucose and lactate in pericontusional areas of the human cerebral cortex, monitored with rapid sampling on-line microdialysis: relationship with depolarisation-like events. J Cereb Blood Flow Metab 25:402–413. doi:10.​1038/​sj.​jcbfm.​9600051 PubMedCrossRef
69.
go back to reference Samuelsson C, Hillered L, Enblad P, Ronne-Engström E (2009) Microdialysis patterns in subarachnoid hemorrhage patients with focus on ischemic events and brain interstitial glutamine levels. Acta Neurochir (Wien) 151:437–446. doi:10.1007/s00701-009-0265-x CrossRef Samuelsson C, Hillered L, Enblad P, Ronne-Engström E (2009) Microdialysis patterns in subarachnoid hemorrhage patients with focus on ischemic events and brain interstitial glutamine levels. Acta Neurochir (Wien) 151:437–446. doi:10.​1007/​s00701-009-0265-x CrossRef
70.
go back to reference Marcoux J, McArthur DA, Miller C et al (2008) Persistent metabolic crisis as measured by elevated cerebral microdialysis lactate-pyruvate ratio predicts chronic frontal lobe brain atrophy after traumatic brain injury. Crit Care Med 36:2871–2877. doi:10.1097/CCM.0b013e318186a4a0 PubMedCrossRef Marcoux J, McArthur DA, Miller C et al (2008) Persistent metabolic crisis as measured by elevated cerebral microdialysis lactate-pyruvate ratio predicts chronic frontal lobe brain atrophy after traumatic brain injury. Crit Care Med 36:2871–2877. doi:10.​1097/​CCM.​0b013e318186a4a0​ PubMedCrossRef
72.
go back to reference Kett-White R, Hutchinson PJ, Al-Rawi PG et al (2002) Adverse cerebral events detected after subarachnoid hemorrhage using brain oxygen and microdialysis probes. Neurosurgery 50:1213–1221 (discussion 1221–1222) PubMed Kett-White R, Hutchinson PJ, Al-Rawi PG et al (2002) Adverse cerebral events detected after subarachnoid hemorrhage using brain oxygen and microdialysis probes. Neurosurgery 50:1213–1221 (discussion 1221–1222) PubMed
73.
go back to reference Reinstrup P, Ståhl N, Mellergård P et al (2000) Intracerebral microdialysis in clinical practice: baseline values for chemical markers during wakefulness, anesthesia, and neurosurgery. Neurosurgery 47:701–710. doi:10.1227/00006123-200009000-00035 PubMed Reinstrup P, Ståhl N, Mellergård P et al (2000) Intracerebral microdialysis in clinical practice: baseline values for chemical markers during wakefulness, anesthesia, and neurosurgery. Neurosurgery 47:701–710. doi:10.​1227/​00006123-200009000-00035 PubMed
74.
75.
76.
82.
go back to reference Nilsson OG, Brandt L, Ungerstedt U, Säveland H (1999) Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 45:1176–1184 (discussion 1184–1185)PubMedCrossRef Nilsson OG, Brandt L, Ungerstedt U, Säveland H (1999) Bedside detection of brain ischemia using intracerebral microdialysis: subarachnoid hemorrhage and delayed ischemic deterioration. Neurosurgery 45:1176–1184 (discussion 1184–1185)PubMedCrossRef
86.
go back to reference Johnston AJ, Steiner LA, Chatfield DA et al (2004) Effect of cerebral perfusion pressure augmentation with dopamine and norepinephrine on global and focal brain oxygenation after traumatic brain injury. Intensive Care Med 30:791–797. doi:10.1007/s00134-003-2155-7 PubMedCrossRef Johnston AJ, Steiner LA, Chatfield DA et al (2004) Effect of cerebral perfusion pressure augmentation with dopamine and norepinephrine on global and focal brain oxygenation after traumatic brain injury. Intensive Care Med 30:791–797. doi:10.​1007/​s00134-003-2155-7 PubMedCrossRef
88.
go back to reference Helbok R, Kurtz P, Schmidt MJ et al (2012) Effects of the neurological wake-up test on clinical examination, intracranial pressure, brain metabolism and brain tissue oxygenation in severely brain-injured patients. Crit Care 16:R226. doi:10.1186/cc11880 PubMedCentralPubMedCrossRef Helbok R, Kurtz P, Schmidt MJ et al (2012) Effects of the neurological wake-up test on clinical examination, intracranial pressure, brain metabolism and brain tissue oxygenation in severely brain-injured patients. Crit Care 16:R226. doi:10.​1186/​cc11880 PubMedCentralPubMedCrossRef
90.
93.
94.
go back to reference Gallagher CN, Carpenter KLH, Grice P et al (2009) The human brain utilizes lactate via the tricarboxylic acid cycle: a 13C-labelled microdialysis and high-resolution nuclear magnetic resonance study. Brain 132:2839–2849. doi:10.1093/brain/awp202 PubMedCrossRef Gallagher CN, Carpenter KLH, Grice P et al (2009) The human brain utilizes lactate via the tricarboxylic acid cycle: a 13C-labelled microdialysis and high-resolution nuclear magnetic resonance study. Brain 132:2839–2849. doi:10.​1093/​brain/​awp202 PubMedCrossRef
95.
go back to reference Hillman J, Milos P, Yu ZQ et al (2006) Intracerebral microdialysis in neurosurgical intensive care patients utilising catheters with different molecular cut-off (20 and 100 kD). Acta Neurochir (Wien) 148:319–324. doi:10.1007/s00701-005-0670-8 CrossRef Hillman J, Milos P, Yu ZQ et al (2006) Intracerebral microdialysis in neurosurgical intensive care patients utilising catheters with different molecular cut-off (20 and 100 kD). Acta Neurochir (Wien) 148:319–324. doi:10.​1007/​s00701-005-0670-8 CrossRef
101.
go back to reference Richards DA, Tolias CM, Sgouros S, Bowery NG (2003) Extracellular glutamine to glutamate ratio may predict outcome in the injured brain: a clinical microdialysis study in children. Pharmacol Res 48:101–109. doi:10.1016/s1043-6618(03)00081-1 PubMed Richards DA, Tolias CM, Sgouros S, Bowery NG (2003) Extracellular glutamine to glutamate ratio may predict outcome in the injured brain: a clinical microdialysis study in children. Pharmacol Res 48:101–109. doi:10.​1016/​s1043-6618(03)00081-1 PubMed
102.
go back to reference Tolias CM, Richards DA, Bowery NG, Sgouros S (2002) Extracellular glutamate in the brains of children with severe head injuries: a pilot microdialysis study. Childs Nerv Syst 18:368–374. doi:10.1007/s00381-002-0623-y PubMed Tolias CM, Richards DA, Bowery NG, Sgouros S (2002) Extracellular glutamate in the brains of children with severe head injuries: a pilot microdialysis study. Childs Nerv Syst 18:368–374. doi:10.​1007/​s00381-002-0623-y PubMed
104.
105.
106.
107.
108.
go back to reference Helbok R, Schiefecker A, Delazer M et al (2014) Cerebral tau is elevated after aneurysmal subarachnoid haemorrhage and associated with brain metabolic distress and poor functional and cognitive long-term outcome. J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp-2013-307326 PubMed Helbok R, Schiefecker A, Delazer M et al (2014) Cerebral tau is elevated after aneurysmal subarachnoid haemorrhage and associated with brain metabolic distress and poor functional and cognitive long-term outcome. J Neurol Neurosurg Psychiatry. doi:10.​1136/​jnnp-2013-307326 PubMed
109.
Metadata
Title
Consensus statement from the 2014 International Microdialysis Forum
Authors
Peter J. Hutchinson
Ibrahim Jalloh
Adel Helmy
Keri L. H. Carpenter
Elham Rostami
Bo-Michael Bellander
Martyn G. Boutelle
Jeff W. Chen
Jan Claassen
Claire Dahyot-Fizelier
Per Enblad
Clare N. Gallagher
Raimund Helbok
Lars Hillered
Peter D. Le Roux
Sandra Magnoni
Halinder S. Mangat
David K. Menon
Carl-Henrik Nordström
Kristine H. O’Phelan
Mauro Oddo
Jon Perez Barcena
Claudia Robertson
Elisabeth Ronne-Engström
Juan Sahuquillo
Martin Smith
Nino Stocchetti
Antonio Belli
T. Adrian Carpenter
Jonathan P. Coles
Marek Czosnyka
Nil Dizdar
J. Clay Goodman
Arun K. Gupta
Troels H. Nielsen
Niklas Marklund
Ambroise Montcriol
Mark T. O’Connell
Maria A. Poca
Asita Sarrafzadeh
Richard J. Shannon
Jane Skjøth-Rasmussen
Peter Smielewski
John F. Stover
Ivan Timofeev
Paul Vespa
Elizabeth Zavala
Urban Ungerstedt
Publication date
01-09-2015
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 9/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-015-3930-y

Other articles of this Issue 9/2015

Intensive Care Medicine 9/2015 Go to the issue