Arterial lactate in traumatic brain injury : Relation to intracranial pressure dynamics, cerebral energy metabolism and clinical outcome

• Purpose: High arterial lactate is associated with disturbed systemic physiology. Lactate can also be used asalternative cerebral fuel and it is involved in regulating cerebral blood flow. This study explored the relation ofendogenous arterial lactate to systemic physiology, pressure autoregulation, cerebral energy metabolism, andclinical outcome in traumatic brain injury (TBI).Method: A retrospective study including 115 patients (consent given) with severe TBI treated in the neurointensivecare unit, Uppsala university hospital, Sweden, 2008–2018. Data from cerebral microdialysis, arterialblood gases, hemodynamics and intracranial pressure were analyzed the first ten days post-injury.Results: Arterial lactate peaked on day 1 post-injury (mean 1.7 ± 0.7 mM) and gradually decreased. Higherarterial lactate correlated with lower age (p-value < 0.05), higher Marshall score (p-value < 0.05) andhigher arterial glucose (p-value < 0.001) in a multiple regression analysis. Higher arterial lactate was associatedwith poor pressure autoregulation (p-value < 0.01), but not to worse cerebral energy metabolism.Higher arterial lactate was also associated with unfavorable clinical outcome (p-value < 0.05).Conclusions: High endogenous arterial lactate is a biomarker of poor systemic physiology and may disturbcerebral blood flow autoregulation.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Medicinska och farmaceutiska grundvetenskaper -- Neurovetenskaper (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Basic Medicine -- Neurosciences (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)

Nyckelord

Cerebral energy metabolism

Clinical outcome

Lactate

Neurointensive-care

Pressure reactivity

Traumatic brain injury

Neurokirurgi

Neurosurgery

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