Cerebral metabolic effects of exogenous lactate supplementation on the injured human brain.

Détails

ID Serval
serval:BIB_49D560B90756
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Cerebral metabolic effects of exogenous lactate supplementation on the injured human brain.
Périodique
Intensive care medicine
Auteur(s)
Bouzat P., Sala N., Suys T., Zerlauth J.B., Marques-Vidal P., Feihl F., Bloch J., Messerer M., Levivier M., Meuli R., Magistretti P.J., Oddo M.
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Statut éditorial
Publié
Date de publication
03/2014
Peer-reviewed
Oui
Volume
40
Numéro
3
Pages
412-421
Langue
anglais
Notes
Publication types: Clinical Trial, Phase II ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
Experimental evidence suggests that lactate is neuroprotective after acute brain injury; however, data in humans are lacking. We examined whether exogenous lactate supplementation improves cerebral energy metabolism in humans with traumatic brain injury (TBI).
We prospectively studied 15 consecutive patients with severe TBI monitored with cerebral microdialysis (CMD), brain tissue PO2 (PbtO2), and intracranial pressure (ICP). Intervention consisted of a 3-h intravenous infusion of hypertonic sodium lactate (aiming to increase systemic lactate to ca. 5 mmol/L), administered in the early phase following TBI. We examined the effect of sodium lactate on neurochemistry (CMD lactate, pyruvate, glucose, and glutamate), PbtO2, and ICP.
Treatment was started on average 33 ± 16 h after TBI. A mixed-effects multilevel regression model revealed that sodium lactate therapy was associated with a significant increase in CMD concentrations of lactate [coefficient 0.47 mmol/L, 95% confidence interval (CI) 0.31-0.63 mmol/L], pyruvate [13.1 (8.78-17.4) μmol/L], and glucose [0.1 (0.04-0.16) mmol/L; all p < 0.01]. A concomitant reduction of CMD glutamate [-0.95 (-1.94 to 0.06) mmol/L, p = 0.06] and ICP [-0.86 (-1.47 to -0.24) mmHg, p < 0.01] was also observed.
Exogenous supplemental lactate can be utilized aerobically as a preferential energy substrate by the injured human brain, with sparing of cerebral glucose. Increased availability of cerebral extracellular pyruvate and glucose, coupled with a reduction of brain glutamate and ICP, suggests that hypertonic lactate therapy has beneficial cerebral metabolic and hemodynamic effects after TBI.

Mots-clé
Adult, Brain/drug effects, Brain/metabolism, Brain Injuries, Traumatic/drug therapy, Brain Injuries, Traumatic/metabolism, Energy Metabolism/drug effects, Female, Frontal Lobe/diagnostic imaging, Glucose/metabolism, Humans, Infusions, Intravenous, Lactic Acid/metabolism, Male, Microdialysis/methods, Middle Aged, Neuroprotection, Prospective Studies, Pyruvic Acid/metabolism, Respiration, Artificial, Sodium Lactate/administration & dosage, Sodium Lactate/pharmacology, Time Factors
Pubmed
Web of science
Création de la notice
11/04/2014 17:42
Dernière modification de la notice
20/08/2019 13:57
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