TY  - JOUR
PY  - 2015//
TI  - Improvement of neuroenergetics by hypertonic lactate therapy in patients with traumatic brain injury is dependent on baseline cerebral lactate/pyruvate ratio
JO  - Journal of neurotrauma
A1  - Quintard, Hervé
A1  - Patet, Camille
A1  - Zerlauth, Jean-Baptiste
A1  - Suys, Tamarah
A1  - Bouzat, Pierre
A1  - Pellerin, Luc
A1  - Meuli, Reto
A1  - Magistretti, Pierre
A1  - Oddo, Mauro
SP  - 681
EP  - 687
VL  - 33
IS  - 7
N2  - 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>
LA  - en
SN  - 0897-7151
UR  - http://dx.doi.org/10.1089/neu.2015.4057
ID  - ref1
ER  -