Measurements of cerebrospinal fluid (CSF) lactate can aid in detecting infections of the central nervous system and surrounding structures. Neurosurgical patients with temporary lumbar or ventricular CSF drainage harbor an increased risk for developing infections of the central nervous system, which require immediate therapeutic responses. Since blood gas analyzers enable rapid blood-lactate measurements, we were interested in finding out if we can reliably measure CSF-lactate by this point-of-care technique. Neurosurgical patients on our intensive care unit (ICU) with either lumbar or external ventricular drainage due to a variety of reasons were included in this prospective observational study. Standard of care included measurements of leucocyte counts, total protein and lactate measurements in CSF by the neurochemical laboratory of our University Medical Center twice a week. With respect to this study, we additionally performed nearly daily measurements of cerebrospinal fluid by blood gas analyzers to determine the reliability of CSF-lactate measured by blood gas analyzers as compared to the standard measurements with a certified device. 62 patients were included in this study. We performed 514 CSF-lactate measurements with blood gas analyzers and compared 180 of these to the in-house standard CSF-lactate measurements. Both techniques correlated highly significantly (Pearson correlation index 0.94) even though lacking full concordance in a Bland–Altman plotting. Of particular importance, regular measurements enabled immediate detection of central infection in three patients who had developed meningitis during the course of their treatment. Blood gas analyzers measure CSF-lactate with sufficient reliability and can help in the timely detection of a developing meningitis. In addition to and triggering established CSF diagnostics, CSF-lactate measurements by blood gas analyzers may improve surveillance of patients with CSF drainage. This study was retrospectively registered on April 20th 2020 in the German trial register. The trial registration number is DRKS00021466.

中文翻译：

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脑脊液中乳酸的即时诊断

脑脊液（CSF）乳酸的测量可以帮助检测中枢神经系统和周围结构的感染。腰部或脑室CSF暂时性引流的神经外科患者发生中枢神经系统感染的风险增加，需要立即进行治疗。由于血气分析仪能够快速进行血乳酸的测量，因此我们有兴趣了解我们是否可以通过这种即时医疗技术可靠地测量CSF乳酸。这项前瞻性观察研究包括因各种原因而在我们的重症监护病房（ICU）上因腰部或外部心室引流而出现的神经外科患者。护理标准包括白细胞计数的测量，我们大学医学中心神经化学实验室每周两次对CSF中的总蛋白和乳酸含量进行测量。对于这项研究，我们还通过血气分析仪对脑脊液进行了近乎每日的测量，以确定由血气分析仪测量的CSF乳酸与经认证的设备进行标准测量相比的可靠性。本研究包括62例患者。我们使用血气分析仪执行了514次CSF乳酸盐测量，并将其中180次与内部标准CSF乳酸盐测量进行了比较。尽管在布兰德-奥特曼绘图中缺乏完全的一致性，但两种技术的相关性都非常高（Pearson相关指数为0.94）。特别重要的是 定期测量可以立即发现三名在治疗过程中发生脑膜炎的患者的中央感染。血气分析仪以足够的可靠性测量CSF乳酸盐，可帮助及时发现发展中的脑膜炎。除了并触发已建立的CSF诊断之外，血气分析仪对CSF乳酸盐的测量可能会改善对CSF引流患者的监测。这项研究已于2020年4月20日在德国审判记录中进行回顾性注册。试用注册号为DRKS00021466。用血气分析仪测量脑脊液乳酸可以改善对脑脊液引流患者的监测。这项研究已于2020年4月20日在德国审判记录中进行回顾性注册。试用注册号为DRKS00021466。用血气分析仪测量脑脊液乳酸可以改善对脑脊液引流患者的监测。这项研究回顾性地于2020年4月20日在德国的试验注册簿中进行了注册。试用注册号为DRKS00021466。