Microdialysis and Jugular Bulb Glucose Profiles During Hyperglycaemic Clamping in Patients With Severe Acute Brain Injury

Rigshospitalet, Denmark14 enrolled

Overview

Acute brain injury is a serious condition that often results in admission to an intensive care unit. Some of the most seriously ill patients are fitted with multimodal neuromonitoring, a newer monitoring modality that can, among other things, measure oxygen tension and sugar levels in brain tissue. It is common clinical practice, but the interaction between the body's sugar levels and the brain's sugar levels is not sufficiently elucidated. The study will investigate the relationship between the body's sugar levels, measured in arterial and venous blood, and the brain's sugar level, measured by microdialysis, in patients with severe acute brain injury. Furthermore, we hope to be able to use our measurements to set up a mathematical model for the brain's sugar uptake.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Acute Brain Injury

Interventions

Following an overnight fast, the investigators will perform simultaneous samples from the arterial line, the venous line, and microdialysis and consider these samples as baseline values. If the patient's blood glucose level is at 8-10 mmol/L at baseline, the investigators will not proceed with the intervention and instead evaluate if the intervention can take place the following day. After baseline values are measured, intravenous glucose 20% (200g/1,000 ml) is infused to raise the glucose levels in both plasma and extravascular glucose compartments with approximately 3 mmol/L.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥ 18 years. * Admission to the neuro-ICU at Rigshospitalet. * Multimodal neuromonitoring Exclusion Criteria: * Closest relative does not understand written and spoken Danish or English. * Patients with known diabetes mellitus upon admission.

Outcomes

Primary Outcomes

(Change in) MD-glucose (mmol/L)

Change in) MD-glucose (mmol/L) over time as a function of (a set change in) arterial blood glucose (mmol/L)

Time frame: Throughout the intervention, approximately five hours

Secondary Outcomes

Jugular vein glucose (mmol/L) over time as a function of arterial blood glucose.

Jugular vein glucose (mmol/L) over time as a function of arterial blood glucose (mmol/L)

Time frame: Throughout the intervention, approximately five hours

Lactate-pyruvate-ratio (LP-ratio) as a function of arterial blood glucose.

Two other microdialysis paramethers, lactate and pyruvat, will be assessed to evaluate the lactate-pyruvate ratio over time as a function of arteriel blood glucose.

Time frame: Throughout the intervention, approximately five hours.