Citation

Quintard H, Patet C, Zerlauth JB, Suys T, Bouzat P, Pellerin L, Meuli R, Magistretti P, Oddo M. J. Neurotrauma 2015; 33(7): 681-687.

Affiliation

CHUV - Lausanne University Hospital, Neuroscience Critical Care Research Group, Intensive Care Medicine, Lausanne, Switzerland ; mauro.oddo@chuv.ch.

Copyright

(Copyright © 2015, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2015.4057

PMID

26421521

Abstract

Energy dysfunction is associated with worse prognosis after traumatic brain injury (TBI). Recent data suggest that hypertonic lactate therapy (HL) improves energy metabolism after TBI. Here, we specifically examined whether the efficacy of HL (3h infusion, 30-40 µmol/kg/min) in improving brain energetics (using cerebral microdialysis [CMD] glucose as main therapeutic endpoint) was dependent on baseline cerebral metabolic state (assessed by CMD lactate/pyruvate ratio [LPR]) and cerebral blood flow (CBF, measured with perfusion CT). Using a prospective cohort of 24 severe TBI patients, we found CMD glucose increase during HL was significant only in the subgroup of patients with elevated CMD LPR >25 (n=13; +0.13 [95% confidence interval 0.08 - 0.19] mmol/L, p<0.001; vs. +0.04 [-0.05 - 0.13] in those with normal LPR, p=0.33, mixed-effects model). In contrast, CMD glucose increase was independent from baseline CBF (coefficient +0.13 [0.04-0.21] mmol/L when global CBF was <32.5 mL/100g/min vs. +0.09 [0.04-0.14] mmol/L at normal CBF, both p<0.005) and systemic glucose. Our data suggest that improvement of brain energetics upon HL infusion seems predominantly dependent on baseline cerebral metabolic state and support the concept that CMD lactate/pyruvate ratio - rather than CBF - could be used as diagnostic indication for systemic lactate supplementation following TBI.

Language: en