Hypertonic lactate for the treatment of intracranial hypertension in patients with acute brain injury.

Détails

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Etat: Public
Version: Final published version
Licence: CC BY 4.0
ID Serval
serval:BIB_8F1889B45609
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Hypertonic lactate for the treatment of intracranial hypertension in patients with acute brain injury.
Périodique
Scientific reports
Auteur⸱e⸱s
Bernini A., Miroz J.P., Abed-Maillard S., Favre E., Iaquaniello C., Ben-Hamouda N., Oddo M.
ISSN
2045-2322 (Electronic)
ISSN-L
2045-2322
Statut éditorial
Publié
Date de publication
22/02/2022
Peer-reviewed
Oui
Volume
12
Numéro
1
Pages
3035
Langue
anglais
Notes
Publication types: Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Résumé
Hypertonic lactate (HL) is emerging as alternative treatment of intracranial hypertension following acute brain injury (ABI), but comparative studies are limited. Here, we examined the effectiveness of HL on main cerebral and systemic physiologic variables, and further compared it to that of standard hypertonic saline (HS). Retrospective cohort analysis of ABI subjects who received sequential osmotherapy with 7.5% HS followed by HL-given at equi-osmolar (2400 mOsmol/L) and isovolumic (1.5 mL/kg) bolus doses-to reduce sustained elevations of ICP (> 20 mmHg). The effect of HL on brain (intracranial pressure [ICP], brain tissue PO <sub>2</sub> [PbtO <sub>2</sub> ], cerebral microdialysis [CMD] glucose and lactate/pyruvate ratio [LPR]) and blood (chloride, pH) variables was examined at different time-points (30, 60, 90, 120 min vs. baseline), and compared to that of HS. A total of 34 treatments among 17 consecutive subjects (13 traumatic brain injury [TBI], 4 non-TBI) were studied. Both agents significantly reduced ICP (p < 0.001, at all time-points tested): when comparing treatment effectiveness, absolute ICP decrease in mmHg and the duration of treatment effect (median time with ICP < 20 mmHg following osmotherapy 183 [108-257] vs. 150 [111-419] min) did not differ significantly between HL and HS (all p > 0.2). None of the treatment had statistically significant effects on PbtO <sub>2</sub> and CMD biomarkers. Treatment with HL did not cause hyperchloremia and resulted in a more favourable systemic chloride balance than HS (Δ blood chloride - 1 ± 2.5 vs. + 4 ± 3 mmol/L; p < 0.001). This is the first clinical study showing that HL has comparative effectiveness than HS for the treatment of intracranial hypertension, while at the same time avoiding hyperchloremic acidosis. Both agents had no significant effect on cerebral oxygenation and metabolism.
Mots-clé
Adult, Brain Injuries/complications, Female, Humans, Hypertonic Solutions, Intracranial Hypertension/drug therapy, Intracranial Hypertension/etiology, Lactates/administration & dosage, Male, Middle Aged, Retrospective Studies, Saline Solution, Hypertonic/administration & dosage, Treatment Outcome, Young Adult
Pubmed
Web of science
Open Access
Oui
Financement(s)
Fonds national suisse / 32003B_155957
Création de la notice
22/02/2022 14:26
Dernière modification de la notice
23/11/2022 7:13
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