Vespa Paul, Wolahan Stephanie, Buitrago-Blanco Manuel, Real Courtney, Ruiz-Tejeda Jesus, McArthur David L, Chiang Jeffrey N, Agoston Denes, Glenn Thomas C
UCLA Department of Neurology, UCLA Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA, 757 Westwood Blvd., Room 6236 A, Los Angeles, CA, 90095, USA.
Department of Oncology, University of California, Irvine, Irvine, USA.
Crit Care. 2025 Apr 14;29(1):153. doi: 10.1186/s13054-025-05374-y.
BACKGROUND/OBJECTIVE: Traumatic brain injury (TBI) is a life-threatening critical neurological injury resulting in widespread metabolic dysfunction in need of novel metabolic therapy. Exogenous lactate appears to improve brain metabolism, but the dose of lactate required remains uncertain. However, the ideal dose of lactate remains unclear. We present a comparison of low vs high dose exogenous sodium lactate infusion in a small cohort and the previous existing literature. We propose a systematic protocol to better study the question of dose-effect n in a future larger study.
We analyzed the metabolic and physiologic effects of various doses of exogenous sodium lactate infusion (ELI) in the existing published literature and our own, single center cohort of patients with coma from severe TBI. Low dose ELI targeting arterial lactate concentration of 2-3 mMol was compared with high dose ELI targeting 4-6 mM. Effects of ELI on brain metabolism and intracranial pressure (ICP) were reviewed. A precision high-dose protocol was piloted and results compared against the existing literature.
Across various studies, metabolic response to ELI was variable and not consistently beneficial. High-dose ELI targeting arterial concentration of 4-6 mM resulted in consistent metabolic improvement and in ICP reduction (p < 0.01). The precision high dose protocol reliably resulted in higher arterial concentration.
High dose ELI appears to have more consistent beneficial effects on brain metabolism and intracranial pressure.
ClinicalTrials.gov ID NCT02776488. Date registered: 2016-05-17. Retrospectively Registered.
背景/目的：创伤性脑损伤（TBI）是一种危及生命的严重神经损伤，会导致广泛的代谢功能障碍，需要新的代谢疗法。外源性乳酸似乎能改善脑代谢，但所需的乳酸剂量仍不确定。然而，理想的乳酸剂量仍不清楚。我们比较了小队列中低剂量与高剂量外源性乳酸钠输注的情况以及先前的现有文献。我们提出了一个系统方案，以便在未来更大规模的研究中更好地研究剂量效应问题。
我们分析了现有已发表文献以及我们自己单中心的重度TBI昏迷患者队列中不同剂量外源性乳酸钠输注（ELI）的代谢和生理效应。将目标动脉乳酸浓度为2 - 3毫摩尔的低剂量ELI与目标浓度为4 - 6毫摩尔的高剂量ELI进行比较。回顾了ELI对脑代谢和颅内压（ICP）的影响。试点采用了精确高剂量方案，并将结果与现有文献进行比较。
在各项研究中，对ELI的代谢反应各不相同，且并非始终有益。目标动脉浓度为4 - 6毫摩尔的高剂量ELI导致一致的代谢改善和ICP降低（p < 0.01）。精确高剂量方案可靠地导致了更高的动脉浓度。
高剂量ELI似乎对脑代谢和颅内压有更一致的有益作用。
ClinicalTrials.gov标识符NCT02776488。注册日期：2016年5月17日。回顾性注册。
