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Improvement of Neuroenergetics by Hypertonic Lactate Therapy in Patients with Traumatic Brain Injury Is Dependent on Baseline Cerebral Lactate/Pyruvate Ratio.
J Neurotrauma. 2016 Apr 01; 33(7):681-7.JN

Abstract

Energy dysfunction is associated with worse prognosis after traumatic brain injury (TBI). Recent data suggest that hypertonic sodium lactate infusion (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 a main therapeutic end-point) was dependent on baseline cerebral metabolic state (assessed by CMD lactate/pyruvate ratio [LPR]) and cerebral blood flow (CBF, measured with perfusion computed tomography [PCT]). 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 (CI) 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/100 g/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 seems predominantly dependent on baseline cerebral metabolic state and support the concept that CMD LPR - rather than CBF - could be used as a diagnostic indication for systemic lactate supplementation following TBI.

Authors+Show Affiliations

1 Department of Intensive Care Medicine, Neuroscience Critical Care Research Group, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland . 2 Department of Anesthesia and Intensive Care, Nice University Hospital , Nice, France .1 Department of Intensive Care Medicine, Neuroscience Critical Care Research Group, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland .3 Department of Medical Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland .1 Department of Intensive Care Medicine, Neuroscience Critical Care Research Group, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland .1 Department of Intensive Care Medicine, Neuroscience Critical Care Research Group, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland . 4 Department of Anesthesia and Intensive Care, Grenoble University Hospital , Grenoble, France .5 Institute of Physiology, University of Lausanne , Lausanne, Switzerland .3 Department of Medical Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland .6 Division of Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology (KAUST) , Thuwal, Kingdom of Saudi Arabia . 7 Centre de Neurosciences Psychiatriques, Department of Psychiatry, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland . 8 Laboratory of Neuroenergetics and Cellular Dynamics, Brain Mind Institute , Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland .1 Department of Intensive Care Medicine, Neuroscience Critical Care Research Group, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland .

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26421521

Citation

Quintard, Hervé, et al. "Improvement of Neuroenergetics By Hypertonic Lactate Therapy in Patients With Traumatic Brain Injury Is Dependent On Baseline Cerebral Lactate/Pyruvate Ratio." Journal of Neurotrauma, vol. 33, no. 7, 2016, pp. 681-7.
Quintard H, Patet C, Zerlauth JB, et al. Improvement of Neuroenergetics by Hypertonic Lactate Therapy in Patients with Traumatic Brain Injury Is Dependent on Baseline Cerebral Lactate/Pyruvate Ratio. J Neurotrauma. 2016;33(7):681-7.
Quintard, H., Patet, C., Zerlauth, J. B., Suys, T., Bouzat, P., Pellerin, L., Meuli, R., Magistretti, P. J., & Oddo, M. (2016). Improvement of Neuroenergetics by Hypertonic Lactate Therapy in Patients with Traumatic Brain Injury Is Dependent on Baseline Cerebral Lactate/Pyruvate Ratio. Journal of Neurotrauma, 33(7), 681-7. https://doi.org/10.1089/neu.2015.4057
Quintard H, et al. Improvement of Neuroenergetics By Hypertonic Lactate Therapy in Patients With Traumatic Brain Injury Is Dependent On Baseline Cerebral Lactate/Pyruvate Ratio. J Neurotrauma. 2016 Apr 1;33(7):681-7. PubMed PMID: 26421521.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improvement of Neuroenergetics by Hypertonic Lactate Therapy in Patients with Traumatic Brain Injury Is Dependent on Baseline Cerebral Lactate/Pyruvate Ratio. AU - Quintard,Hervé, AU - Patet,Camille, AU - Zerlauth,Jean-Baptiste, AU - Suys,Tamarah, AU - Bouzat,Pierre, AU - Pellerin,Luc, AU - Meuli,Reto, AU - Magistretti,Pierre J, AU - Oddo,Mauro, Y1 - 2015/12/15/ PY - 2015/10/1/entrez PY - 2015/10/1/pubmed PY - 2017/1/11/medline KW - cerebral blood flow KW - cerebral microdialysis KW - hypertonic KW - lactate KW - traumatic brain injury SP - 681 EP - 7 JF - Journal of neurotrauma JO - J. Neurotrauma VL - 33 IS - 7 N2 - Energy dysfunction is associated with worse prognosis after traumatic brain injury (TBI). Recent data suggest that hypertonic sodium lactate infusion (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 a main therapeutic end-point) was dependent on baseline cerebral metabolic state (assessed by CMD lactate/pyruvate ratio [LPR]) and cerebral blood flow (CBF, measured with perfusion computed tomography [PCT]). 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 (CI) 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/100 g/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 seems predominantly dependent on baseline cerebral metabolic state and support the concept that CMD LPR - rather than CBF - could be used as a diagnostic indication for systemic lactate supplementation following TBI. SN - 1557-9042 UR - https://www.unboundmedicine.com/medline/citation/26421521/Improvement_of_Neuroenergetics_by_Hypertonic_Lactate_Therapy_in_Patients_with_Traumatic_Brain_Injury_Is_Dependent_on_Baseline_Cerebral_Lactate/Pyruvate_Ratio_ L2 - https://www.liebertpub.com/doi/full/10.1089/neu.2015.4057?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -