title: Improvement of Neuroenergetics by Hypertonic Lactate Therapy in Patients with Traumatic Brain Injury Is Dependent on Baseline Cerebral Lactate/Pyruvate Ratio.
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.affiliation: 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 .
authors.forename: Hervé
authors.initials: H
authors.lastname: Quintard
authors.affiliation: 1 Department of Intensive Care Medicine, Neuroscience Critical Care Research Group, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland .
authors.forename: Camille
authors.initials: C
authors.lastname: Patet
authors.affiliation: 3 Department of Medical Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland .
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Zerlauth
authors.affiliation: 1 Department of Intensive Care Medicine, Neuroscience Critical Care Research Group, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland .
authors.forename: Tamarah
authors.initials: T
authors.lastname: Suys
authors.affiliation: 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 .
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouzat
authors.affiliation: 5 Institute of Physiology, University of Lausanne , Lausanne, Switzerland .
authors.forename: Luc
authors.initials: L
authors.lastname: Pellerin
authors.affiliation: 3 Department of Medical Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland .
authors.forename: Reto
authors.initials: R
authors.lastname: Meuli
authors.affiliation: 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 .
authors.forename: Pierre J
authors.initials: PJ
authors.lastname: Magistretti
authors.affiliation: 1 Department of Intensive Care Medicine, Neuroscience Critical Care Research Group, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne University Hospital , Lausanne, Switzerland .
authors.forename: Mauro
authors.initials: M
authors.lastname: Oddo
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D000070642:Brain Injuries, Traumatic / Q000188:drug therapy* / Q000378:metabolism*; D004734:Energy Metabolism / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007262:Infusions, Intravenous; D019344:Lactic Acid / Q000378:metabolism*; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D011446:Prospective Studies; D019289:Pyruvic Acid / Q000378:metabolism*; D019354:Sodium Lactate / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D019344:Lactic Acid; D019289:Pyruvic Acid; D019354:Sodium Lactate
keywords: cerebral blood flow; cerebral microdialysis; hypertonic; lactate; traumatic brain injury