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

Autor: Bernini A; Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV-Lausanne University Hospital and Faculty of Biology and Medicine, 1011, Lausanne, Switzerland., Miroz JP; Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV-Lausanne University Hospital and Faculty of Biology and Medicine, 1011, Lausanne, Switzerland., Abed-Maillard S; Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV-Lausanne University Hospital and Faculty of Biology and Medicine, 1011, Lausanne, Switzerland., Favre E; Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV-Lausanne University Hospital and Faculty of Biology and Medicine, 1011, Lausanne, Switzerland., Iaquaniello C; Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV-Lausanne University Hospital and Faculty of Biology and Medicine, 1011, Lausanne, Switzerland.; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Ben-Hamouda N; Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV-Lausanne University Hospital and Faculty of Biology and Medicine, 1011, Lausanne, Switzerland., Oddo M; Neuroscience Critical Care Research Group, Department of Intensive Care Medicine, CHUV-Lausanne University Hospital and Faculty of Biology and Medicine, 1011, Lausanne, Switzerland. mauro.oddo@chuv.ch.; Medical Directorate for Research, Education and Innovation, CHUV, Lausanne, Switzerland. mauro.oddo@chuv.ch.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2022 Feb 22; Vol. 12 (1), pp. 3035. Date of Electronic Publication: 2022 Feb 22.
DOI: 10.1038/s41598-022-07129-z
Abstrakt: 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 2 [PbtO 2 ], 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 2 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.
(© 2022. The Author(s).)
Databáze: MEDLINE
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