Association between elevated brain tissue glycerol levels and poor outcome following severe traumatic brain injury

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  • 1 Department of Anesthesiology and Intensive Care Medicine, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany; Servico de Neurocirurgia, Centro Hospitalar de Gaia, Faculdade de Medicina da Universidade do Porto, Portugal; Department of Neurosurgery, Inselspital Bern, Switzerland; Division of Neurosurgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia; and Department of Neurosurgery, University of Miami, Lois Pope Life Center, Miami, Florida
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Object. Glycerol is considered to be a marker of cell membrane degradation and thus cellular lysis. Recently, it has become feasible to measure via microdialysis cerebral extracellular fluid (ECF) glycerol concentrations at the patient's bedside. Therefore the aim of this study was to investigate the ECF concentration and time course of glycerol after severe traumatic brain injury (TBI) and its relationship to patient outcome and other monitoring parameters.

Methods. As soon as possible after injury for up to 4 days, 76 severely head-injured patients were monitored using a microdialysis probe (cerebral glycerol) and a Neurotrend sensor (brain tissue PO2) in uninjured brain tissue confirmed by computerized tomography scanning. The mean brain tissue glycerol concentration in all monitored patients decreased significantly from 206 ± 31 µmol/L on Day 1 to 9 ± 3 µmol/L on Day 4 after injury (p < 0.0001). Note, however, that there was no significant difference in the time course between patients with a favorable outcome (Glasgow Outcome Scale [GOS] Scores 4 and 5) and those with an unfavorable outcome (GOS Scores 1–3). Significantly increased glycerol concentrations were observed when brain tissue PO2 was less than 10 mm Hg or when cerebral perfusion pressure was less than 70 mm Hg.

Conclusions. Based on results in the present study one can infer that microdialysate glycerol is a marker of severe tissue damage, as seen immediately after brain injury or during profound tissue hypoxia. Given that brain tissue glycerol levels do not yet add new clinically significant information, however, routine monitoring of this parameter following traumatic brain injury needs further validation.

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Contributor Notes

Address reprint requests to: Ross Bullock, M.D., Ph.D., Division of Neurosurgery, Medical College of Virginia, Virginia Commonwealth University, P.O. Box 980631, Richmond, Virginia 23298–0631. email: robulloc@hsc.vcu.edu.
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