Improvement of Neuroenergetics by Hypertonic Lactate Therapy in Patients with Traumatic Brain Injury Is Dependent on Baseline Cerebral Lactate/Pyruvate Ratio.

Détails

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Etat: Public
Version: de l'auteur
ID Serval
serval:BIB_ADD77D241C1A
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Improvement of Neuroenergetics by Hypertonic Lactate Therapy in Patients with Traumatic Brain Injury Is Dependent on Baseline Cerebral Lactate/Pyruvate Ratio.
Périodique
Journal of neurotrauma
Auteur(s)
Quintard H., Patet C., Zerlauth J.B., Suys T., Bouzat P., Pellerin L., Meuli R., Magistretti P.J., Oddo M.
ISSN
1557-9042 (Electronic)
ISSN-L
0897-7151
Statut éditorial
Publié
Date de publication
01/04/2016
Peer-reviewed
Oui
Volume
33
Numéro
7
Pages
681-687
Langue
anglais
Notes
Publication types: Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Résumé
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.

Mots-clé
Adult, Blood Glucose/metabolism, Brain Injuries, Traumatic/drug therapy, Brain Injuries, Traumatic/metabolism, Energy Metabolism/drug effects, Energy Metabolism/physiology, Female, Humans, Imaging, Three-Dimensional, Infusions, Intravenous, Lactic Acid/metabolism, Male, Microdialysis, Middle Aged, Prospective Studies, Pyruvic Acid/metabolism, Sodium Lactate/therapeutic use, Tomography, X-Ray Computed, Young Adult
Pubmed
Open Access
Oui
Création de la notice
19/10/2015 14:40
Dernière modification de la notice
20/08/2019 15:17
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