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We implemented a structured cerebral microdialysis (CMD) based protocol using\u00a0the lactate\/pyruvate ratio (LPR) as an indicator of the cerebral energy metabolic status in the neurocritical care decision making, using an LPR\u2009\u2265\u200930 as a cutoff suggesting an\u00a0energy metabolic disturbance. We hypothesized that CMD monitoring could contribute to active, protocol-driven therapeutic interventions that may lead to the improved management of patients with SAH.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Between 2018 and 2020, 49 invasively monitored patients with SAH, median Glasgow Coma Scale 11 (range 3\u201315), and World Federation of Neurosurgical Societies scale 4 (range 1\u20135) on admission receiving CMD were included. We defined a major CMD event as an\u00a0LPR\u2009\u2265\u200940 for\u2009\u2265\u20092\u00a0h and a minor CMD event as an\u00a0LPR\u2009\u2265\u200930 for\u2009\u2265\u20092\u00a0h.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We analyzed 7,223 CMD samples over a median of 6\u00a0days (5\u20138). Eight patients had no CMD events. In 41 patients, 113 minor events were recorded, and in 23 patients 42 major events were recorded. Our local protocols were adhered to in 40 major (95%) and 98 minor events (87%), with an active intervention in 32 (76%) and 71 (63%), respectively. Normalization of energy metabolic status (defined as four consecutive samples\u2009with LPR\u00a0&lt;\u200930 for minor and\u2009LPR\u00a0&lt;\u200940 for major events) was seen after 69% of major and 59% of minor events. The incidence of DCI-related infarcts was 10% (five patients), with only two observed in a CMD-monitored brain region.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Active interventions were initiated in a majority of LPR events based on CMD monitoring. A low DCI incidence was observed, which may be associated with the active interventions. The potential aid of CMD in the clinical decision-making targeting DCI needs confirmation in additional SAH studies.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s12028-022-01492-5","type":"journal-article","created":{"date-parts":[[2022,4,29]],"date-time":"2022-04-29T20:26:45Z","timestamp":1651264005000},"page":"255-266","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Cerebral Microdialysis-Based Interventions Targeting Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage"],"prefix":"10.1007","volume":"37","author":[{"given":"Jakob","family":"Winberg","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Holm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cederberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malin","family":"Rundgren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Kronvall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9797-5626","authenticated-orcid":false,"given":"Niklas","family":"Marklund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,4,29]]},"reference":[{"issue":"12","key":"1492_CR1","doi-asserted-by":"publisher","first-page":"1365","DOI":"10.1136\/jnnp.2007.117655","volume":"78","author":"NK de Rooij","year":"2007","unstructured":"de Rooij NK, Linn FH, van der Plas JA, Algra A, Rinkel GJ. 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