Ichai C, Armando G, Orban JC, Berthier F, Rami L, Samat-Long C, Grimaud D, Leverve XSodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients. Intensive Care Med 35:471-479

Faculté de Médecine and CHU de Nice, Service de Réanimation, Hôpital Saint-Roch, Nice Cedex 1, France.
Intensive Care Medicine (Impact Factor: 7.21). 09/2008; 35(3):471-9. DOI: 10.1007/s00134-008-1283-5
Source: PubMed


Traumatic brain injury (TBI) is still a major cause of mortality and morbidity. Recent trials have failed to demonstrate a beneficial outcome from therapeutic treatments such as corticosteroids, hypothermia and hypertonic saline. We investigated the effect of a new hyperosmolar solution based on sodium lactate in controlling raised intracranial pressure (ICP).
Prospective open randomized study in an adult ICU.
Thirty-four patients with isolated severe TBI (Glasgow Coma Scale <or= 8) and intracranial hypertension were allocated to receive equally hyperosmolar and isovolumic therapy, consisting of either mannitol or sodium lactate. Rescue therapy by crossover to the alternative treatment was indicated when ICP could not be controlled. The primary endpoint was efficacy in lowering ICP after 4 h, with a secondary endpoint of the percentage of successfully treated episodes of intracranial hypertension. The analysis was performed with both intention-to-treat and actual treatments provided.
Compared to mannitol, the effect of the lactate solution on ICP was significantly more pronounced (7 vs. 4 mmHg, P = 0.016), more prolonged (fourth-hour-ICP decrease: -5.9 +/- 1 vs. -3.2 +/- 0.9 mmHg, P = 0.009) and more frequently successful (90.4 vs. 70.4%, P = 0.053).
Acute infusion of a sodium lactate-based hyperosmolar solution is effective in treating intracranial hypertension following traumatic brain injury. This effect is significantly more pronounced than that of an equivalent osmotic load of mannitol. Additionally, in this specific group of patients, long-term outcome was better in terms of GOS in those receiving as compared to mannitol. Larger trials are warranted to confirm our findings.

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Available from: Jean-Christophe Orban, Nov 26, 2014
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    • "Both studies concluded that infused lactate was effectively metabolized after TBI (Bouzat et al. 2014; Carpenter et al. 2014). Exogenous lactate was found to dilate cerebral vasculature and increase cerebral blood flow (Gordon et al. 2008) and lactate infusion compared favorably to mannitol in reducing ICP after TBI (Ichai et al. 2009). However, the acceptance of this lactate augmentation intervention strategy is still being debated (Nordstrom and Nielsen 2014). "
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    • "Although equimolar infusion of 20% mannitol is as effective as 7.45% hypertonic saline (HSS) in decreasing ICP in patients with brain injury but in patients with severe TBI and elevated ICP refractory to previous mannitol treatment, 7.5% hypertonic saline administration showed a significant increase in brain oxygenation and improved cerebral and systemic hemodynamics.[2428] Small trials have also investigated the effects of other hyperosmolar solutions including sodium bicarbonate and sodium lactate and these agents were found to have similar effects as mannitol or hypertonic saline.[29] "
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