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Cerebrospinal fluid in critical illness.
B Venkatesh1, P Scott, M Ziegenfuss
1Intensive Care Facility, Division of Anaesthesiology and Intensive Care, Royal Brisbane Hospital, Brisbane, Queensland. venkateshb@health.qld.gov.au
Summary
Cerebrospinal fluid (CSF) analysis is crucial for diagnosing infections in critically ill patients. While advanced CSF tests offer insights, their diagnostic and prognostic value in critical illness remains limited compared to clinical examination.
Area of Science:
- Neurology
- Critical Care Medicine
- Clinical Chemistry
Background:
- Cerebrospinal fluid (CSF) analysis is a key diagnostic tool in critical care, particularly for neurological and neurosurgical patients.
- Conventional CSF tests include cell counts, protein, sugar, and microbiology.
- Recent advances have introduced new laboratory tests for CSF analysis.
Purpose of the Study:
- To review the physiology, pathophysiology, and diagnostic advancements of CSF analysis in critical illness.
- To examine the pharmacokinetics and pharmacodynamics of drugs administered via intravenous and intrathecal routes in the CSF.
Main Methods:
- A comprehensive literature review of peer-reviewed articles published between 1966 and 1999.
- MEDLINE database search focused on cerebrospinal fluid research.
Main Results:
- CSF examination is integral to assessing critically ill neurological/neurosurgical patients, with its primary value in diagnosing meningitis.
- Newer CSF laboratory tests enhance understanding of pathophysiology but have limited diagnostic or prognostic utility.
- The review covers alterations in CSF composition during critical illness and drug pharmacokinetics/pharmacodynamics in the CSF.
Conclusions:
- Current CSF investigation in critical illness is mainly limited to diagnosing infectious processes.
- Studies on CSF analysis for predicting outcomes have not surpassed conventional clinical examination.
- Future advancements in understanding neurological function and biochemical analysis may yield valuable diagnostic and prognostic CSF markers.