期刊
CURRENT OPINION IN CRITICAL CARE
卷 20, 期 2, 页码 133-140出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MCC.0000000000000072
关键词
acute brain injury; brain metabolism; lactate; microdialysis
资金
- Swiss National Science Foundation [320030_138191]
- European Critical Care Research Network, European Society of Intensive Care Medicine
- Gueules Cassees Foundation
- Swiss National Science Foundation (SNF) [320030_138191] Funding Source: Swiss National Science Foundation (SNF)
Purpose of reviewEnergy metabolism is increasingly recognized as a key factor in the pathogenesis of acute brain injury (ABI). We review the role of cerebral lactate metabolism and summarize evidence showing that lactate may act as supplemental fuel after ABI.Recent findingsThe role of cerebral lactate has shifted from a waste product to a potentially preferential fuel and signaling molecule. According to the astrocyte-neuron lactate shuttle model, glycolytic lactate might act as glucose-sparing substrate. Lactate also is emerging as a key signal to regulate cerebral blood flow (CBF) and a neuroprotective agent after experimental ABI. Clinical investigation using cerebral microdialysis shows the existence of two main lactate patterns, ischemic - from anaerobic metabolism - and nonischemic, from activated glycolysis, whereby lactate can be used as supplemental energy fuel. Preliminary clinical data suggests hypertonic lactate solutions improve cerebral energy metabolism and are an effective treatment for elevated intracranial pressure (ICP) after ABI.SummaryLactate can be a supplemental fuel for the injured brain and is important to regulate glucose metabolism and CBF. Exogenous lactate supplementation may be neuroprotective after experimental ABI. Recent clinical data from ABI patients suggest hypertonic lactate solutions may be a valid therapeutic option for secondary energy dysfunction and elevated ICP.
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