{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T20:13:51Z","timestamp":1776111231592,"version":"3.50.1"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T00:00:00Z","timestamp":1728950400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T00:00:00Z","timestamp":1728950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100017530","name":"Fresenius Kabi","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017530","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Innsbruck and Medical University of Innsbruck"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurocrit Care"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Pathologically low brain glucose levels, referred to as neuroglucopenia, are associated with unfavorable outcomes in neurocritical care patients. We sought to investigate whether an increase in serum glucose levels would be associated with a reduction of neuroglucopenia.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>In this retrospective analysis of prospectively collected data, we included 55 consecutive patients with spontaneous subarachnoid hemorrhage who underwent cerebral microdialysis (CMD) monitoring. Neuroglucopenia was defined as CMD-glucose levels\u2009&lt;\u20090.7\u00a0mmol\/l. We identified systemic glucose liberalization events, defined as a day with median serum glucose levels\u2009&lt;\u2009150\u00a0mg\/dl, followed by a day with median serum glucose levels\u2009&gt;\u2009150\u00a0mg\/dl, and compared concentrations of cerebral metabolites between these days. Unfavorable outcome was defined as modified Rankin Scale score\u2009\u2265\u20093 at 3 months after the bleeding.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Episodes of neuroglucopenia were more frequent in patients with unfavorable outcome (19.8% [19.3\u201320.3%] vs. 10.9% [10.4\u201311.5%], <jats:italic>p<\/jats:italic>\u2009=\u20090.007). Sixty-nine systemic glucose liberalization events were identified in 40 patients. Blood glucose levels increased from 141.2 (138.7\u2013143.6) mg\/dl to 159.5 (157.0\u2013162.2) mg\/dl (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), CMD-glucose levels increased from 1.44 (1.39\u20131.50) mmol\/l to 1.68 (1.62\u20131.75) mmol\/l (<jats:italic>p<\/jats:italic>\u2009=\u20090.001), and the frequency of neuroglucopenia decreased from 24.7% (22.9\u201326.5%) to 20.2% (18.7\u201321.8%) (<jats:italic>p<\/jats:italic>\u2009=\u20090.002) during these events. Liberalization was not associated with changes in CMD-lactate, CMD-pyruvate, CMD\u2013lactate-to-pyruvate ratio, CMD-glutamate, or CMD-glycerol.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>In conclusion, the liberalization of serum glucose concentrations to levels between 150 and 180 mg\/dl was associated with a significant reduction of neuroglucopenia.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s12028-024-02126-8","type":"journal-article","created":{"date-parts":[[2024,10,15]],"date-time":"2024-10-15T19:01:43Z","timestamp":1729018903000},"page":"343-350","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Liberalization of the Systemic Glucose Management is Associated with a Reduced Frequency of Neuroglucopenia in Subarachnoid Hemorrhage Patients: An Observational Cohort Study"],"prefix":"10.1007","volume":"42","author":[{"given":"Mario","family":"Kofler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Lindner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Verena","family":"Rass","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogdan A.","family":"Ianosi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauma","family":"Putnina","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Kindl","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alois J.","family":"Schiefecker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maxime","family":"Gaasch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronny","family":"Beer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Rhomberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudius","family":"Thom\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erich","family":"Schmutzhard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bettina","family":"Pfausler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5682-0145","authenticated-orcid":false,"given":"Raimund","family":"Helbok","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,10,15]]},"reference":[{"issue":"7","key":"2126_CR1","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/S1474-4422(09)70126-7","volume":"8","author":"DJ Nieuwkamp","year":"2009","unstructured":"Nieuwkamp DJ, Setz LE, Algra A, Linn FH, de Rooij NK, Rinkel GJ. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol. 2009;8(7):635\u201342.","journal-title":"Lancet Neurol"},{"issue":"8","key":"2126_CR2","doi-asserted-by":"crossref","first-page":"e519","DOI":"10.1161\/STROKEAHA.110.581975","volume":"41","author":"T Al-Khindi","year":"2010","unstructured":"Al-Khindi T, Macdonald RL, Schweizer TA. Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. Stroke. 2010;41(8):e519\u201336.","journal-title":"Stroke"},{"key":"2126_CR3","doi-asserted-by":"crossref","first-page":"565","DOI":"10.3389\/fneur.2017.00565","volume":"8","author":"R Helbok","year":"2017","unstructured":"Helbok R, Kofler M, Schiefecker AJ, Gaasch M, Rass V, Pfausler B, et al. Clinical use of cerebral microdialysis in patients with aneurysmal subarachnoid hemorrhage-state of the art. Front Neurol. 2017;8:565.","journal-title":"Front Neurol"},{"issue":"9","key":"2126_CR4","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1007\/s00134-015-3930-y","volume":"41","author":"PJ Hutchinson","year":"2015","unstructured":"Hutchinson PJ, Jalloh I, Helmy A, Carpenter KL, Rostami E, Bellander BM, et al. Consensus statement from the 2014 International Microdialysis Forum. Intensive Care Med. 2015;41(9):1517\u201328.","journal-title":"Intensive Care Med"},{"issue":"3","key":"2126_CR5","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1177\/0271678X17700434","volume":"38","author":"M Kofler","year":"2018","unstructured":"Kofler M, Schiefecker AJ, Beer R, Gaasch M, Rhomberg P, Stover J, et al. Enteral nutrition increases interstitial brain glucose levels in poor-grade subarachnoid hemorrhage patients. J Cereb Blood Flow Metab. 2018;38(3):518\u201327.","journal-title":"J Cereb Blood Flow Metab"},{"issue":"13","key":"2126_CR6","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1056\/NEJMoa0810625","volume":"360","author":"N-SS Investigators","year":"2009","unstructured":"Investigators N-SS, Finfer S, Chittock DR, Su SY, Blair D, Foster D, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283\u201397.","journal-title":"N Engl J Med"},{"issue":"12","key":"2126_CR7","doi-asserted-by":"crossref","first-page":"3233","DOI":"10.1097\/CCM.0b013e31818f4026","volume":"36","author":"M Oddo","year":"2008","unstructured":"Oddo M, Schmidt JM, Carrera E, Badjatia N, Connolly ES, Presciutti M, et al. Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: a microdialysis study. Crit Care Med. 2008;36(12):3233\u20138.","journal-title":"Crit Care Med"},{"issue":"1","key":"2126_CR8","doi-asserted-by":"crossref","first-page":"R9","DOI":"10.1186\/cc6776","volume":"12","author":"F Schlenk","year":"2008","unstructured":"Schlenk F, Graetz D, Nagel A, Schmidt M, Sarrafzadeh AS. Insulin-related decrease in cerebral glucose despite normoglycemia in aneurysmal subarachnoid hemorrhage. Crit Care. 2008;12(1):R9.","journal-title":"Crit Care"},{"issue":"1","key":"2126_CR9","doi-asserted-by":"crossref","first-page":"R15","DOI":"10.1186\/cc11160","volume":"16","author":"JM Schmidt","year":"2012","unstructured":"Schmidt JM, Claassen J, Ko SB, Lantigua H, Presciutti M, Lee K, et al. Nutritional support and brain tissue glucose metabolism in poor-grade SAH: a retrospective observational study. Crit Care. 2012;16(1):R15.","journal-title":"Crit Care"},{"issue":"6","key":"2126_CR10","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1161\/STR.0b013e3182587839","volume":"43","author":"ES Connolly Jr","year":"2012","unstructured":"Connolly ES Jr, Rabinstein AA, Carhuapoma JR, Derdeyn CP, Dion J, Higashida RT, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association\/american Stroke Association. Stroke. 2012;43(6):1711\u201337.","journal-title":"Stroke"},{"issue":"2","key":"2126_CR11","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1159\/000346087","volume":"35","author":"T Steiner","year":"2013","unstructured":"Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G, et al. European stroke organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis. 2013;35(2):93\u2013112.","journal-title":"Cerebrovasc Dis"},{"issue":"2","key":"2126_CR12","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/MCC.0000000000000798","volume":"27","author":"V Rass","year":"2021","unstructured":"Rass V, Helbok R. How to diagnose delayed cerebral ischaemia and symptomatic vasospasm and prevent cerebral infarction in patients with subarachnoid haemorrhage. Curr Opin Crit Care. 2021;27(2):103\u201314.","journal-title":"Curr Opin Crit Care"},{"issue":"9","key":"2126_CR13","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.1161\/hs0901.095677","volume":"32","author":"J Claassen","year":"2001","unstructured":"Claassen J, Bernardini GL, Kreiter K, Bates J, Du YE, Copeland D, et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke. 2001;32(9):2012\u201320.","journal-title":"Stroke"},{"issue":"5","key":"2126_CR14","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1161\/01.STR.0000015624.29071.1F","volume":"33","author":"J Claassen","year":"2002","unstructured":"Claassen J, Carhuapoma JR, Kreiter KT, Du EY, Connolly ES, Mayer SA. Global cerebral edema after subarachnoid hemorrhage: frequency, predictors, and impact on outcome. Stroke. 2002;33(5):1225\u201332.","journal-title":"Stroke"},{"issue":"1","key":"2126_CR15","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/s12028-019-00713-8","volume":"32","author":"M Kofler","year":"2020","unstructured":"Kofler M, Gaasch M, Rass V, Schiefecker AJ, Ianosi B, Lindner A, et al. The importance of probe location for the interpretation of cerebral microdialysis data in subarachnoid hemorrhage patients. Neurocrit Care. 2020;32(1):135\u201344.","journal-title":"Neurocrit Care"},{"issue":"1","key":"2126_CR16","doi-asserted-by":"crossref","first-page":"66","DOI":"10.3171\/2011.3.JNS10899","volume":"115","author":"M Zetterling","year":"2011","unstructured":"Zetterling M, Hillered L, Enblad P, Karlsson T, Ronne-Engstrom E. Relation between brain interstitial and systemic glucose concentrations after subarachnoid hemorrhage. J Neurosurg. 2011;115(1):66\u201374.","journal-title":"J Neurosurg"},{"issue":"6","key":"2126_CR17","doi-asserted-by":"crossref","first-page":"e424","DOI":"10.1161\/STROKEAHA.108.529974","volume":"40","author":"ND Kruyt","year":"2009","unstructured":"Kruyt ND, Biessels GJ, de Haan RJ, Vermeulen M, Rinkel GJ, Coert B, et al. Hyperglycemia and clinical outcome in aneurysmal subarachnoid hemorrhage: a meta-analysis. Stroke. 2009;40(6):e424\u201330.","journal-title":"Stroke"},{"issue":"4","key":"2126_CR18","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00134-020-05944-4","volume":"46","author":"I Vanhorebeek","year":"2020","unstructured":"Vanhorebeek I, Latronico N, Van den Berghe G. ICU-acquired weakness. Intensive Care Med. 2020;46(4):637\u201353.","journal-title":"Intensive Care Med"}],"container-title":["Neurocritical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12028-024-02126-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12028-024-02126-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12028-024-02126-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,30]],"date-time":"2025-03-30T16:25:53Z","timestamp":1743351953000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12028-024-02126-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,15]]},"references-count":18,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["2126"],"URL":"https:\/\/doi.org\/10.1007\/s12028-024-02126-8","relation":{},"ISSN":["1541-6933","1556-0961"],"issn-type":[{"value":"1541-6933","type":"print"},{"value":"1556-0961","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,15]]},"assertion":[{"value":"20 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 August 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 October 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"All authors declare that there is no conflict of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All provisions of the Helsinki Declaration were followed. The conduct of this study was approved by the ethics committee of the Medical University of Innsbruck, Austria (AN3898 285\/4.8).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"Informed consent was obtained from all patients or a legal representative, according to Austrian legislation.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}