@article{ref1,
title="Improvement of neuroenergetics by hypertonic lactate therapy in patients with traumatic brain injury is dependent on baseline cerebral lactate/pyruvate ratio",
journal="Journal of neurotrauma",
year="2015",
author="Quintard, Hervé and Patet, Camille and Zerlauth, Jean-Baptiste and Suys, Tamarah and Bouzat, Pierre and Pellerin, Luc and Meuli, Reto and Magistretti, Pierre and Oddo, Mauro",
volume="33",
number="7",
pages="681-687",
abstract="Energy dysfunction is associated with worse prognosis after traumatic brain injury (TBI). Recent data suggest that hypertonic lactate therapy (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 main therapeutic endpoint) was dependent on baseline cerebral metabolic state (assessed by CMD lactate/pyruvate ratio [LPR]) and cerebral blood flow (CBF, measured with perfusion CT). 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 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/100g/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 infusion seems predominantly dependent on baseline cerebral metabolic state and support the concept that CMD lactate/pyruvate ratio - rather than CBF - could be used as diagnostic indication for systemic lactate supplementation following TBI.<p /> <p>Language: en</p>",
language="en",
issn="0897-7151",
doi="10.1089/neu.2015.4057",
url="http://dx.doi.org/10.1089/neu.2015.4057"
}