Hypertonic Lactate to Improve Cerebral Perfusion and Glucose Availability After Acute Brain Injury

Objectives: Lactate promotes cerebral blood flow and is an efficient substrate for the brain, particularly at times of glucose shortage. Hypertonic lactate is neuroprotective after experimental brain injury; however, human data are limited. Design: Prospective study (clinicaltrials.gov NCT01573507). Setting: Academic ICU. Patients: Twenty-three brain-injured subjects (13 traumatic brain injury/10 subarachnoid hemorrhage; median age, 59 yr [41–65 yr]; median Glasgow Coma Scale, 6 [3–7]). Interventions: Three-hour IV infusion of hypertonic lactate (sodium lactate, 1,000 mmol/L; concentration, 30 µmol/kg/min) administered 39 hours (26–49 hr) from injury. Measurements and Main Results: We examined the effect of hypertonic lactate on cerebral perfusion (using transcranial Doppler) and brain energy metabolism (using cerebral microdialysis). The majority of subjects (13/23 = 57%) had reduced brain glucose availability (baseline pretreatment cerebral microdialysis glucose, 0.1). Conclusions: This is the first clinical demonstration that hypertonic lactate resuscitation improves both cerebral perfusion and brain glucose availability after brain injury. These cerebral vascular and metabolic effects appeared related to brain lactate supplementation rather than to systemic effects. Drs. Carteron and Solari are co-first authors and contributed equally to this work. Supported, in part, by grants from the Swiss National Science Foundation (320030_138191 and 32003B_155957 [to Dr. Oddo]), the Novartis Foundation for Biomedical Research (to Dr. Oddo), and the Société Française d’Anesthésie et de Réanimation and the Fondation des Gueules Cassées (both to Dr. Carteron). Dr. Hirt received other support from Boehringer Ingelheim (speaker fees and travel grants, not related to this work) and research grants not in relation with this work from the Swiss Science Foundation, the Biaggi Foundation, and the Juchum Foundation. Dr. Oddo received support for article research from the Swiss National Science Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: mauro.oddo@chuv.ch Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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