RESUMO
INTRODUCTION: Prognosis after resuscitation from cardiac arrest (CA) remains poor, with high morbidity and mortality as a result of extensive cardiac and brain injury and lack of effective treatments. Hypertonic sodium lactate (HSL) may be beneficial after CA by buffering severe metabolic acidosis, increasing brain perfusion and cardiac performance, reducing cerebral swelling, and serving as an alternative energetic cellular substrate. The aim of this study was to test the effects of HSL infusion on brain and cardiac injury in an experimental model of CA. METHODS: After a 10-min electrically induced CA followed by 5 min of cardiopulmonary resuscitation maneuvers, adult swine (n = 35) were randomly assigned to receive either balanced crystalloid (controls, n = 11) or HSL infusion started during cardiopulmonary resuscitation (CPR, Intra-arrest, n = 12) or after return of spontaneous circulation (Post-ROSC, n = 11) for the subsequent 12 h. In all animals, extensive multimodal neurological and cardiovascular monitoring was implemented. All animals were treated with targeted temperature management at 34 °C. RESULTS: Thirty-four of the 35 (97.1%) animals achieved ROSC; one animal in the Intra-arrest group died before completing the observation period. Arterial pH, lactate and sodium concentrations, and plasma osmolarity were higher in HSL-treated animals than in controls (p < 0.001), whereas potassium concentrations were lower (p = 0.004). Intra-arrest and Post-ROSC HSL infusion improved hemodynamic status compared to controls, as shown by reduced vasopressor requirements to maintain a mean arterial pressure target > 65 mmHg (p = 0.005 for interaction; p = 0.01 for groups). Moreover, plasma troponin I and glial fibrillary acid protein (GFAP) concentrations were lower in HSL-treated groups at several time-points than in controls. CONCLUSIONS: In this experimental CA model, HSL infusion was associated with reduced vasopressor requirements and decreased plasma concentrations of measured biomarkers of cardiac and cerebral injury.
Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Traumatismos Cardíacos , Animais , Suínos , Lactato de Sódio/farmacologia , Lactato de Sódio/uso terapêutico , Parada Cardíaca/complicações , Parada Cardíaca/tratamento farmacológico , Vasoconstritores , Encéfalo/metabolismo , Biomarcadores/metabolismo , Modelos Animais de DoençasRESUMO
Traditionally, clinicians consider lactate as a waste product of anaerobic glycolysis. Interestingly, research has shown that lactate may serve as an alternative fuel for the brain to protect it against harm. The increasing scientific awareness of the potential beneficial side of lactate, however, is entering the clinic rather slowly. Following this, and realizing that the application of potential novel therapeutic strategies in pediatric populations often lags behind the development in adults, this review summarizes the key data on therapeutic use of intravenous infusion of sodium lactate in humans. PubMed and clinicaltrial.gov were searched up until November 2021 focusing on interventional studies in humans. Thirty-four articles were included in this review, with protocols of lactate infusion in adults with diabetes mellitus, traumatic brain injury, Alzheimer's disease, and cardiac disease. One study on lactate infusion in children was also included. Results of our literature search show that sodium lactate can be safely administrated, without major side effects. Additionally, the present literature clearly shows the potential benefits of therapeutic lactate infusion under certain pathological circumstances, including rather common clinical conditions like traumatic brain injury. CONCLUSION: This review shows that lactate is a save, alternative energy source for the adult brain warranting studies on the potential therapeutic effects of sodium lactate infusion in children. WHAT IS KNOWN: ⢠Lactate is generally considered a waste product of anaerobic glycolysis. However, lactate also is an alternative fuel for different organs, including the brain. ⢠Lactate infusion is not incorporated in standard care for any patient population. WHAT IS NEW: ⢠Thirty-four studies investigated the therapeutic use of intravenous sodium lactate in different patient populations, all with different study protocols. ⢠Literature shows that lactate infusion may have beneficial effects in case of hypoglycemia, traumatic brain injury, and cardiac failure without the risk of major side effects.
Assuntos
Lesões Encefálicas Traumáticas , Hipoglicemia , Adulto , Lesões Encefálicas Traumáticas/tratamento farmacológico , Criança , Humanos , Hipoglicemia/tratamento farmacológico , Ácido Láctico/uso terapêutico , Lactato de Sódio/uso terapêutico , ResíduosRESUMO
BACKGROUND: Hypertonic sodium lactate (HSL) may be of interest during inflammation. We aimed to evaluate its effects during experimental sepsis in rats (cecal ligation and puncture (CLP)). METHODS: Three groups were analyzed (n = 10/group): sham, CLP-NaCl 0.9%, and CLP-HSL (2.5 mL/kg/h of fluids for 18 h after CLP). Mesenteric microcirculation, echocardiography, cytokines, and biochemical parameters were evaluated. Two additional experiments were performed for capillary leakage (Evans blue, n = 5/group) and cardiac hemodynamics (n = 7/group). RESULTS: HSL improved mesenteric microcirculation (CLP-HSL 736 [407-879] vs. CLP-NaCl 241 [209-391] UI/pixel, p = 0.0006), cardiac output (0.34 [0.28-0.43] vs. 0.14 [0.10-0.18] mL/min/g, p < 0.0001), and left ventricular fractional shortening (55 [46-73] vs. 39 [33-52] %, p = 0.009). HSL also raised dP/dtmax slope (6.3 [3.3-12.1] vs. 2.7 [2.0-3.9] 103 mmHg/s, p = 0.04), lowered left ventricular end-diastolic pressure-volume relation (1.9 [1.1-2.3] vs. 3.0 [2.2-3.7] RVU/mmHg, p = 0.005), and reduced Evans blue diffusion in the gut (37 [31-43] vs. 113 [63-142], p = 0.03), the lung (108 [82-174] vs. 273 [222-445], p = 0.006), and the liver (24 [14-37] vs. 70 [50-89] ng EB/mg, p = 0.04). Lactate and 3-hydroxybutyrate were higher in CLP-HSL (6.03 [3.08-10.30] vs. 3.19 [2.42-5.11] mmol/L, p = 0.04; 400 [174-626] vs. 189 [130-301] µmol/L, p = 0.03). Plasma cytokines were reduced in HSL (IL-1ß, 172 [119-446] vs. 928 [245-1470] pg/mL, p = 0.004; TNFα, 17.9 [12.5-50.3] vs. 53.9 [30.8-85.6] pg/mL, p = 0.005; IL-10, 352 [267-912] vs. 905 [723-1243] pg/mL) as well as plasma VEGF-A (198 [185-250] vs. 261 [250-269] pg/mL, p = 0.009). CONCLUSIONS: Hypertonic sodium lactate fluid protects against cardiac dysfunction, mesenteric microcirculation alteration, and capillary leakage during sepsis and simultaneously reduces inflammation and enhances ketone bodies.
Assuntos
Inflamação , Microcirculação , Sepse , Lactato de Sódio , Animais , Ratos , Análise de Variância , Modelos Animais de Doenças , Ecocardiografia/métodos , Fatores de Crescimento Endotelial/análise , Fatores de Crescimento Endotelial/sangue , Testes de Função Cardíaca/métodos , Soluções Hipertônicas/uso terapêutico , Inflamação/tratamento farmacológico , Inflamação/fisiopatologia , Interleucina-10/análise , Interleucina-10/sangue , Interleucina-1beta/análise , Interleucina-1beta/sangue , Microcirculação/efeitos dos fármacos , Microcirculação/fisiologia , Estudos Prospectivos , Sepse/tratamento farmacológico , Sepse/fisiopatologia , Lactato de Sódio/farmacologia , Lactato de Sódio/uso terapêutico , Sindecana-1/análise , Sindecana-1/sangue , Fator de Necrose Tumoral alfa/análise , Fator de Necrose Tumoral alfa/sangueRESUMO
Carbohydrate fuel augmentation following traumatic brain injury may be a viable treatment to improve recovery when cerebral oxidative metabolism of glucose is depressed. We performed a primed constant sodium L-lactate infusion in 11 moderate to severely brain injured adults. Blood was collected before and periodically during the infusion study. We quantified global cerebral uptake of glucose and lactate and other systemic metabolites associated with energy metabolism. Our hypothesis was that cerebral lactate uptake, as measured by the arteriovenous difference of lactate (AVDlac), would increase in severely injured TBI patients in the neurocritical care unit. Infusion of sodium L-lactate changed net cerebral lactate release, where the arteriovenous difference of lactate is negative, to net cerebral lactate uptake. Results from a mixed effects model of AVDlac with the fixed effects of infusion time, arterial lactate concentration, arterial glucose concentration and arteriovenous difference of glucose shows that doubling arterial lactate concentration (from .92 to 1.84 mM) results in an increase in AVDlac from -.078 mM to .090 mM. We did not detect changes in systemic glucose during the course of the infusion study and observed significant changes in alanine (30% [20 39]), glutamine (34% [24 43]), acetate (87% [60 113]), valine (40% [28 51]), and leucine (24% [16 32]) from baseline levels. Further studies are required to establish the impact of lactate supplementation on cerebral and systemic flux of lactate, on gluconeogenesis, and on the impact on cerebral energetics following injury. © 2017 Wiley Periodicals, Inc.
Assuntos
Lesões Encefálicas Traumáticas/tratamento farmacológico , Lesões Encefálicas Traumáticas/metabolismo , Ácido Láctico/metabolismo , Lactato de Sódio/uso terapêutico , Adulto , Idoso , Glicemia/metabolismo , Encéfalo/metabolismo , Metabolismo Energético/efeitos dos fármacos , Feminino , Humanos , Infusões Intravenosas , Ácido Láctico/sangue , Masculino , Pessoa de Meia-Idade , Lactato de Sódio/administração & dosagemRESUMO
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, < 1 mmol/L) despite normal baseline intracranial pressure (10 [7-15] mm Hg). Hypertonic lactate was associated with increased cerebral microdialysis lactate (+55% [31-80%]) that was paralleled by an increase in middle cerebral artery mean cerebral blood flow velocities (+36% [21-66%]) and a decrease in pulsatility index (-21% [13-26%]; all p < 0.001). Cerebral microdialysis glucose increased above normal range during hypertonic lactate (+42% [30-78%]; p < 0.05); reduced brain glucose availability correlated with a greater improvement of cerebral microdialysis glucose (Spearman r = -0.53; p = 0.009). No significant changes in cerebral perfusion pressure, mean arterial pressure, systemic carbon dioxide, and blood glucose were observed during hypertonic lactate (all p > 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.
Assuntos
Glicemia/metabolismo , Lesões Encefálicas Traumáticas/tratamento farmacológico , Lesões Encefálicas Traumáticas/metabolismo , Ácido Láctico/metabolismo , Lactato de Sódio/uso terapêutico , Adulto , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Feminino , Lobo Frontal/diagnóstico por imagem , Escala de Coma de Glasgow , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Ultrassonografia Doppler em CoresRESUMO
BACKGROUND: The mechanisms by which hypertonic sodium lactate (HSL) solution act in injured brain are unclear. We investigated the effects of HSL on brain metabolism, oxygenation, and perfusion in a rodent model of diffuse traumatic brain injury (TBI). METHODS: Thirty minutes after trauma, anaesthetised adult rats were randomly assigned to receive a 3 h infusion of either a saline solution (TBI-saline group) or HSL (TBI-HSL group). The sham-saline and sham-HSL groups received no insult. Three series of experiments were conducted up to 4 h after TBI (or equivalent) to investigate: 1) brain oedema using diffusion-weighted magnetic resonance imaging and brain metabolism using localized 1H-magnetic resonance spectroscopy (n = 10 rats per group). The respiratory control ratio was then determined using oxygraphic analysis of extracted mitochondria, 2) brain oxygenation and perfusion using quantitative blood-oxygenation-level-dependent magnetic resonance approach (n = 10 rats per group), and 3) mitochondrial ultrastructural changes (n = 1 rat per group). RESULTS: Compared with the TBI-saline group, the TBI-HSL and the sham-operated groups had reduced brain oedema. Concomitantly, the TBI-HSL group had lower intracellular lactate/creatine ratio [0.049 (0.047-0.098) vs 0.097 (0.079-0.157); P < 0.05], higher mitochondrial respiratory control ratio, higher tissue oxygen saturation [77% (71-79) vs 66% (55-73); P < 0.05], and reduced mitochondrial cristae thickness in astrocytes [27.5 (22.5-38.4) nm vs 38.4 (31.0-47.5) nm; P < 0.01] compared with the TBI-saline group. Serum sodium and lactate concentrations and serum osmolality were higher in the TBI-HSL than in the TBI-saline group. CONCLUSIONS: These findings indicate that the hypertonic sodium lactate solution can reverse brain oxygenation and metabolism dysfunction after traumatic brain injury through vasodilatory, mitochondrial, and anti-oedema effects.
Assuntos
Lesões Encefálicas Traumáticas/terapia , Encéfalo/metabolismo , Lactato de Sódio/uso terapêutico , Animais , Edema Encefálico/etiologia , Edema Encefálico/metabolismo , Edema Encefálico/patologia , Edema Encefálico/prevenção & controle , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/metabolismo , Lesões Encefálicas Traumáticas/fisiopatologia , Córtex Cerebral/ultraestrutura , Modelos Animais de Doenças , Hidratação/métodos , Masculino , Microscopia Eletrônica , Mitocôndrias/efeitos dos fármacos , Mitocôndrias/ultraestrutura , Consumo de Oxigênio/efeitos dos fármacos , Ratos Wistar , Solução Salina Hipertônica/uso terapêutico , Lactato de Sódio/farmacologiaRESUMO
BACKGROUND: Sodium lactate has been shown to improve hemodynamics and avoid fluid overload. The objective of this study was to confirm a beneficial effect on fluid balance with sodium lactate infusion and to specify whether the advantage of lactate is related to a negative chloride balance, its particular metabolism, or simply its energy load. METHODS: This was an interventional, randomized, open-label, controlled experimental study. Fifteen female "large white" pigs (2 months old) were challenged with intravenous infusion of Escherichia coli endotoxin. Three groups of five animals were randomly assigned to receive different fluids: a treatment group received sodium lactate 11.2% (SL group); an isotonic control group received 0.9% NaCl (NC group); and a hypertonic control group, with the same amount of osmoles and sodium as the SL group, received sodium bicarbonate 8.4% (SB group). In order to provide the same energy load in the three groups, control groups were perfused with an equivalent energy supply. Statistical analysis was performed with non-parametric tests and the Dunn correction for multiple comparisons at p < 0.05. RESULTS: Fluid and chloride balance, hemodynamics, oxygenation markers, and microcirculatory parameters were measured over a 5-h period. Cumulative fluid balance was significantly lower in the SL group (550 (415-800) mL; median (interquartile range)) compared to the NC group (1100 (920-1640) mL, p = 0.01) and the SB group (935 (790-1220) mL, p = 0.03). Hemodynamics, cardiac efficiency, and microcirculation were significantly enhanced in the SL group, resulting in a significant improvement in oxygen delivery (SL group 417 (305-565) mL/min/m2 at 300 min versus the NC (207 (119-272) mL/min/m2, p = 0.01) and the SB (278, (211-315) mL/min/m2, p = 0.03) groups). Oxygenation markers (arterial oxygen partial pressure (PaO2)/inspired oxygen fraction (FiO2), mixed venous oxygen saturation (SvO2), and venoarterial carbon dioxide tension difference (Pv-aCO2) were enhanced with sodium lactate infusion. Chloride balance was equivalent in both hypertonic groups and significantly reduced compared to the NC group. CONCLUSION: Sodium lactate infusion improves fluid balance and hemodynamics. The advantage of lactate does not seem to be explained by its energy load or by the induced negative chloride balance with subsequent water movements.
Assuntos
Hidratação/normas , Hemodinâmica/fisiologia , Choque Séptico/metabolismo , Bicarbonato de Sódio/uso terapêutico , Lactato de Sódio/uso terapêutico , Animais , Feminino , Hidratação/métodos , Infusões Intravenosas/métodos , Monitorização Fisiológica/métodos , Choque Séptico/tratamento farmacológico , Bicarbonato de Sódio/farmacologia , Cloreto de Sódio/farmacologia , Cloreto de Sódio/uso terapêutico , Lactato de Sódio/farmacologia , Suínos , Equilíbrio Hidroeletrolítico/fisiologiaRESUMO
Fluid resuscitation in the critically ill is a hot topic. The current strategy of rapid and adequate resuscitation in shock followed by conservative fluid administration is often difficult to achieve with standard crystalloid solutions. Research into alternative intravenous fluids tailored to individual patient needs is required. In the previous issue of Critical Care, Somasetia and colleagues compare the effects of hypertonic sodium lactate with the World Health Organization-recommended strategy of Ringer's lactate resuscitation in children with severe Dengue, a viral infection for which causal treatment and vaccination are not available. The results not only suggest unimpaired lactate metabolism during shock in children but document improvement in endothelial barrier function, limited coagulopathy, and avoidance of fluid overload with hypertonic sodium lactate. Their study invites several important questions to be answered. Is hypertonicity or lactate per se important for the beneficial effects? Are the metabolic or anti-inflammatory effects responsible? Is the raised lactate in shock an adaptive response? Should reduction in lactate levels be the goal of resuscitation? These questions may trigger further research into the role of lactate and lactate-based intravenous fluids in resuscitation of the critically ill.
Assuntos
Hidratação , Ressuscitação , Dengue Grave/terapia , Lactato de Sódio/uso terapêutico , Feminino , Humanos , MasculinoRESUMO
INTRODUCTION: Dengue shock syndrome (DSS) fluid resuscitation by following the World Health Organization (WHO) guideline usually required large volumes of Ringer lactate (RL) that might induce secondary fluid overload. Our objective was to compare the effectiveness of the recommended volume of RL versus a smaller volume of a hypertonic sodium lactate solution (HSL) in children with DSS. The primary end point was to evaluate the effect of HSL on endothelial cell inflammation, assessed by soluble vascular cell adhesion molecule-1 (sVCAM-1) measurements. Secondarily, we considered the effectiveness of HSL in restoring hemodynamic fluid balance, acid-base status, and sodium and chloride balances, as well as in-hospital survival. METHODS: A prospective randomized single-blind clinical trial including 50 DSS children was conducted in the Pediatrics Department of Hasan Sadikin Hospital, Bandung, Indonesia. Only pediatric patients (2 to 14 years old) fulfilling the WHO criteria for DSS and new to resuscitation treatments were eligible. Patients were resuscitated with either HSL (5 ml/kg/BW in 15 minutes followed by 1 ml/kg/BW/h for 12 hours), or RL (20 ml/kg/BW in 15 minutes followed by decreasing doses of 10, 7, 5, and 3 ml/kg BW/h for 12 hours). RESULTS: In total, 50 patients were randomized and included in outcome and adverse-event analysis; 46 patients (8.2 ± 0.5 years; 24.9 ± 1.9 kg; mean ± SEM) completed the protocol and were fully analyzed (24 and 22 subjects in the HSL and RL groups, respectively). Baseline (prebolus) data were similar in both groups. Hemodynamic recovery, plasma expansion, clinical outcome, and survival rate were not significantly different in the two groups, whereas fluid accumulation was one third lower in the HSL than in the RL group. Moreover, HSL was responsible for a partial recovery from endothelial dysfunction, as indicated by the significant decrease in sVCAM-1. CONCLUSION: Similar hemodynamic shock recovery and plasma expansion were achieved in both groups despite much lower fluid intake and fluid accumulation in the HSL group. TRIAL REGISTRATION: ClinicalTrials.gov NCT00966628. Registered 26 August 2009.
Assuntos
Hidratação , Ressuscitação , Dengue Grave/terapia , Lactato de Sódio/uso terapêutico , Adolescente , Criança , Pré-Escolar , Feminino , Hidratação/métodos , Humanos , Indonésia , Soluções Isotônicas/uso terapêutico , Masculino , Estudos Prospectivos , Lactato de Ringer , Método Simples-Cego , Resultado do Tratamento , Molécula 1 de Adesão de Célula Vascular/sangueRESUMO
Hyperosmolar lactate-based solutions have been used for fluid resuscitation in ICU patients. The positive effects observed with these fluids have been attributed to both lactate metabolism and the hypertonic nature of the solutions. In a recent issue of Critical Care, Duburcq and colleagues studied three types of fluid infused at the same volume in a porcine model of endotoxic shock. The control group was resuscitated with 0.9% NaCl, and the two other groups received either hypertonic sodium-lactate or hypertonic sodium-bicarbonate. The two hypertonic fluids proved to be more effective than 0.9% NaCl for resuscitation in this model. However, some parameters were more effectively corrected by hypertonic sodium-lactate than by hypertonic sodium-bicarbonate, suggesting that lactate metabolism was beneficial in these cases.
Assuntos
Hidratação , Hemodinâmica/efeitos dos fármacos , Microcirculação/efeitos dos fármacos , Choque Séptico/tratamento farmacológico , Lactato de Sódio/uso terapêutico , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Animais , FemininoRESUMO
INTRODUCTION: Based on the potential interest in sodium lactate as an energy substrate and resuscitative fluid, we investigated the effects of hypertonic sodium lactate in a porcine endotoxic shock. METHODS: Fifteen anesthetized, mechanically ventilated pigs were challenged with intravenous infusion of E. coli endotoxin. Three groups of five animals were randomly assigned to receive 5 mL/kg/h of different fluids: a treatment group received hypertonic sodium lactate 11.2% (HSL group); an isotonic control group receiving 0.9% NaCl (NC group); a hypertonic control group with the same amount of osmoles and sodium than HSL group receiving hypertonic sodium bicarbonate 8.4% (HSB group). Hemodynamic and oxygenation variables, urine output and fluid balance were measured at baseline and at 30, 60, 120, 210 and 300 min. Skin microvascular blood flow at rest and during reactive hyperemia was obtained using a laser Doppler flowmetry technique. Results were given as median with interquartile ranges. RESULTS: Endotoxin infusion resulted in hypodynamic shock. At 300 min, hemodynamics and oxygenation were significantly enhanced in HSL group: mean arterial pressure (103 [81-120] mmHg vs. 49 [41-62] in NC group vs. 71 [60-78] in HSB group), cardiac index (1.6 [1.2-1.8] L/min/m2 vs. 0.9 [0.5-1.1] in NC group vs. 1.3 [0.9-1.6] in HSB group) and partial pressure of oxygen (366 [308-392] mmHg vs. 166 [130-206] in NC group vs. 277 [189-303] in HSB group). At the same time, microvascular reactivity was significantly better in HSL group with a lower venoarterial CO2 tension difference (5.5 [4-10] mmHg vs. 17 [14-25] in NC group vs. 14 [12-15] in HSB group). The cumulative fluid balance was lower in HSL group (-325 [-655; -150] mL) compared to NC (+560 [+230; +900] mL, p = 0.008) and HSB (+185 [-110; +645] mL, p = 0.03) groups. CONCLUSIONS: In our hypodynamic model of endotoxic shock, infusion of hypertonic sodium lactate improves hemodynamic and microvascular reactivity with a negative fluid balance and a better oxygenation.
Assuntos
Hidratação , Hemodinâmica/efeitos dos fármacos , Microcirculação/efeitos dos fármacos , Choque Séptico/tratamento farmacológico , Lactato de Sódio/uso terapêutico , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Animais , Glicemia/metabolismo , Modelos Animais de Doenças , Feminino , Concentração de Íons de Hidrogênio , Soluções Hipertônicas/uso terapêutico , Infusões Intravenosas , Rim/fisiopatologia , Ácido Láctico/sangue , Estudos Prospectivos , Distribuição Aleatória , Choque Séptico/fisiopatologia , Suínos , UrinaRESUMO
In a recent issue of Critical Care, 0.5 M sodium lactate infusion for 24 hours was reported to increase cardiac output in patients with acute heart failure. This effect was associated with a concomitant metabolic alkalosis and a negative water balance. Growing data strongly support the role of lactate as a preferential oxidizable substrate to supply energy metabolism leading to improved organ function (heart and brain especially) in ischemic conditions. Due to its sodium/chloride imbalance, this solution prevents hyperchloremic acidosis and limits fluid overload despite the obligatory high sodium load. Sodium lactate solution therefore shows many advantages and appears a very promising means for resuscitation of critically ill patients. Further studies are needed to establish the most appropriate dose and indications for sodium lactate infusion in order to prevent the occurrence of severe hypernatremia and metabolic alkalosis.
Assuntos
Desequilíbrio Ácido-Base/prevenção & controle , Hidratação/métodos , Insuficiência Cardíaca/tratamento farmacológico , Lactato de Sódio/uso terapêutico , Desequilíbrio Hidroeletrolítico/induzido quimicamente , Desequilíbrio Ácido-Base/etiologia , Acidose/etiologia , Acidose/prevenção & controle , Alcalose/prevenção & controle , Biomarcadores , Débito Cardíaco/efeitos dos fármacos , Humanos , Hiperlactatemia/induzido quimicamente , Hiperlactatemia/prevenção & controle , Hipernatremia/induzido quimicamente , Hipernatremia/prevenção & controle , Hipopotassemia/induzido quimicamente , Hipopotassemia/prevenção & controle , Prognóstico , Lactato de Sódio/administração & dosagem , Lactato de Sódio/efeitos adversos , Volume Sistólico/efeitos dos fármacos , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Desequilíbrio Hidroeletrolítico/prevenção & controleRESUMO
BACKGROUND: Traumatic hemorrhagic shock (THS) is the main cause of death in trauma patients with high mortality. Rapid control of the source of bleeding and early resuscitation are crucial to clinical treatment. Guidelines recommend isotonic crystal resuscitation when blood products are not immediately available. However, the selection of isotonic crystals has been controversial. Sodium bicarbonate Ringer solutions (BRS), containing sodium bicarbonate, electrolyte levels, and osmotic pressures closer to plasma, are ideal. Therefore, in this study, we will focus on the effects of BRS on the first 6 h of resuscitation, complications, and 7-day survival in patients with THS. METHODS: /design. This single-center, prospective, randomized controlled trial will focus on the efficacy and safety of BRS in early THS resuscitation. A total of 400 adults THS patients will be enrolled in this study. In addition to providing standard care, enrolled patients will be randomized in a 1:1 ratio to receive resuscitation with BRS (test group) or sodium lactate Ringer's solution (control group) until successful resuscitation from THS. Lactate clearance at different time points (0.5, 1, 1.5, 3, and 6 h) and shock duration after drug administration will be compared between the two groups as primary end points. Secondary end points will compare coagulation function, temperature, acidosis, inflammatory mediator levels, recurrence of shock, complications, medication use, and 7-day mortality between the two groups. Patients will be followed up until discharge or 7 days after discharge. DISCUSSION: At present, there are still great differences in the selection of resuscitation fluids, and there is a lack of systematic and detailed studies to compare and observe the effects of various resuscitation fluids on the effectiveness and safety of early resuscitation in THS patients. This trial will provide important clinical data for resuscitation fluid selection and exploration of safe dose of BRS in THS patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR), ChiCTR2100045044. Registered on 4 April 2021.
Assuntos
Choque Hemorrágico , Adulto , Eletrólitos , Hidratação/efeitos adversos , Hemorragia/tratamento farmacológico , Humanos , Mediadores da Inflamação , Soluções Isotônicas/efeitos adversos , Estudos Prospectivos , Ressuscitação/efeitos adversos , Solução de Ringer/uso terapêutico , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/tratamento farmacológico , Bicarbonato de Sódio/efeitos adversos , Lactato de Sódio/uso terapêuticoRESUMO
The activity of complex preparation Sorbilact was studied up in the patients, suffering obturative jaundice after surgical interventions on hepatopancreatoduodenal zone organs. Preparation Sorbilact causes antishock, proenergetic, desintoxication, diuretic and procinetic intestinal effects. The Sorbilact inclusion in complex of postoperative treatment of patients secures possibility of early administration of the enteral probe nutrition, promotes the trophic state optimization as well as the rehabilitation period duration shortening.
Assuntos
Ductos Biliares/cirurgia , Pseudo-Obstrução Intestinal/prevenção & controle , Procedimentos de Cirurgia Plástica/efeitos adversos , Lactato de Sódio/uso terapêutico , Sorbitol/uso terapêutico , Adulto , Idoso , Combinação de Medicamentos , Nutrição Enteral , Feminino , Humanos , Infusões Intravenosas , Pseudo-Obstrução Intestinal/tratamento farmacológico , Pseudo-Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Peristaltismo/efeitos dos fármacos , Lactato de Sódio/administração & dosagem , Sorbitol/administração & dosagem , Resultado do TratamentoAssuntos
Anestesia Geral/veterinária , Antibacterianos/efeitos adversos , Doenças do Cão/induzido quimicamente , Fluoroquinolonas/efeitos adversos , Animais , Antibacterianos/administração & dosagem , Cães , Hipersensibilidade a Drogas/terapia , Hipersensibilidade a Drogas/veterinária , Fluoroquinolonas/administração & dosagem , Hipotensão/induzido quimicamente , Hipotensão/terapia , Hipotensão/veterinária , Masculino , Lactato de Sódio/administração & dosagem , Lactato de Sódio/uso terapêutico , Taquicardia/induzido quimicamente , Taquicardia/terapia , Taquicardia/veterinária , Taquipneia/induzido quimicamente , Taquipneia/terapia , Taquipneia/veterináriaRESUMO
The authors have studied influence of infusion of 800 ml RHEOSORBILACTUM, 500 ml VENOFUNDIN and 800 ml of 0,9% isotonic solution of sodium chloride with speed of 50-55 ml/mines on hemostasis, the maintenance of a liquid in the thorax, hemodynamic parameters in 60 patients with traumatic shock. It was revealed that the use of investigated volume of RHEOSORBILACTUM increases reliably (P<0,05) oxygen delivery for the account of the expressed haemodynamic effect which duration is less than during the use of VENOFUNDIN. It was revealed also that RHEOSORBILACTUM increases reliably (P<0,05) quantity of liquid in the thorax without an considerable difference with other investigated medications. There was no influence of RHEOSORBILACTUM on time of trombus formation tests--prothrombin time, the international normalized index, activated partial thromboplastin time.
Assuntos
Eletrólitos/uso terapêutico , Hemodinâmica/efeitos dos fármacos , Derivados de Hidroxietil Amido/uso terapêutico , Substitutos do Plasma/uso terapêutico , Choque Traumático/terapia , Sorbitol/uso terapêutico , APACHE , Adolescente , Adulto , Eletrólitos/administração & dosagem , Feminino , Humanos , Derivados de Hidroxietil Amido/administração & dosagem , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Substitutos do Plasma/administração & dosagem , Choque Traumático/diagnóstico , Choque Traumático/fisiopatologia , Lactato de Sódio/administração & dosagem , Lactato de Sódio/uso terapêutico , Sorbitol/administração & dosagem , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To compare two solutions for fluid resuscitation in post-coronary artery bypass grafting (CABG) surgery patients: Ringer's lactate (RL) versus a new solution containing half-molar sodium-lactate (HL). DESIGN: Prospective randomized open label study. SETTING: The first 12 h post-CABG surgery in an intensive care unit (ICU). PATIENTS: There were 230 patients enrolled in the study: 208 were analyzed, with 109 from the HL group and 99 from the RL group. INTERVENTIONS: Patients received over the first 12 h post-CABG 10 ml kg BW(-1) HL solution in the HL group versus 30 ml kg BW(-1) of RL solution in the RL group. MEASUREMENTS AND RESULTS: Hemodynamic status, body fluid balance and inotrope utilization were compared in the two groups. Post-operative cardiac index increase was significantly higher in HL than in RL (P = 0.02), while mean arterial pressure and other hemodynamic parameters were comparable together with urinary output, indicating similar tissue perfusion in both the groups despite a much lower fluid infusion in the HL group. Therefore, a significant negative fluid balance was achieved in the HL but not in the RL group (-790 +/- 71 vs. +43 +/- 115 mL 12 h(-1), P < 0.0001 for HL and RL, respectively). None of the enrolled patients exhibited side effects related to the treatment. CONCLUSION: Half-molar lactate solution is effective for fluid resuscitation in post-CABG patients. Compared to Ringer's Lactate, its use results in a significantly higher cardiac index with less volume being infused, resulting in a very negative post-operative body fluid balance.
Assuntos
Ponte de Artéria Coronária , Hidratação/métodos , Soluções Hipertônicas/uso terapêutico , Soluções Isotônicas/uso terapêutico , Cuidados Pós-Operatórios/métodos , Lactato de Sódio/uso terapêutico , Débito Cardíaco , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Lactato de Ringer , Lactato de Sódio/metabolismo , Equilíbrio Hidroeletrolítico/fisiologiaRESUMO
Energy dysfunction is associated with worse prognosis after traumatic brain injury (TBI). Recent data suggest that hypertonic sodium lactate infusion (HL) improves energy metabolism after TBI. Here, we specifically examined whether the efficacy of HL (3h infusion, 30-40 µmol/kg/min) in improving brain energetics (using cerebral microdialysis [CMD] glucose as a main therapeutic end-point) was dependent on baseline cerebral metabolic state (assessed by CMD lactate/pyruvate ratio [LPR]) and cerebral blood flow (CBF, measured with perfusion computed tomography [PCT]). Using a prospective cohort of 24 severe TBI patients, we found CMD glucose increase during HL was significant only in the subgroup of patients with elevated CMD LPR >25 (n = 13; +0.13 [95% confidence interval (CI) 0.08-0.19] mmol/L, p < 0.001; vs. +0.04 [-0.05-0.13] in those with normal LPR, p = 0.33, mixed-effects model). In contrast, CMD glucose increase was independent from baseline CBF (coefficient +0.13 [0.04-0.21] mmol/L when global CBF was <32.5 mL/100 g/min vs. +0.09 [0.04-0.14] mmol/L at normal CBF, both p < 0.005) and systemic glucose. Our data suggest that improvement of brain energetics upon HL seems predominantly dependent on baseline cerebral metabolic state and support the concept that CMD LPR - rather than CBF - could be used as a diagnostic indication for systemic lactate supplementation following TBI.
Assuntos
Lesões Encefálicas Traumáticas/tratamento farmacológico , Lesões Encefálicas Traumáticas/metabolismo , Ácido Láctico/metabolismo , Ácido Pirúvico/metabolismo , Lactato de Sódio/uso terapêutico , Adulto , Glicemia/metabolismo , Metabolismo Energético/efeitos dos fármacos , Metabolismo Energético/fisiologia , Feminino , Humanos , Imageamento Tridimensional , Infusões Intravenosas , Masculino , Microdiálise , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Hypertonic sodium lactate (HTL) expands intravascular volume and may provide an alternative substrate for cellular metabolism in sepsis. We compared the effects of HTL, hypertonic saline (HTS), 0.9% ("normal") saline (NS) and Ringer's lactate (RL) on hemodynamics, sublingual and renal microcirculation, renal, mesenteric and brain perfusion, renal and cerebral metabolism, and survival in anesthetized, mechanically ventilated, adult female sheep. Animals (7 in each group) were randomized to receive a bolus (over 15-min) of 3âmL/kg 0.5âM HTL, 3âmL/kg 3% HTS, 10.8âmL/kg NS, or 10.8âmL/kg RL at 2, 6, and 10âh after induction of fecal peritonitis, followed by 2-h infusions of 1âmL/kg/h (HTL/HTS groups) or 3.6âmL/kg/h (NS/RL groups). Animals also received RL and hydroxyethyl starch (ratio 1:1) titrated to maintain pulmonary artery occlusion pressure at baseline levels throughout the experiment. Animals were observed until their spontaneous death. Fluid balance was lower in the HTL and HTS groups than in the other groups from 4âh. Hemodynamic variables were similar among groups during the first 12âh, but thereafter the HTL group had more pronounced decreases in blood pressure and cardiac function. Sublingual and renal microcirculatory abnormalities occurred earlier in the HTL group. Kidney and brain perfusion decreased more rapidly in the HTL group. Median survival times were significantly shorter in the HTL (17âh) and NS (16âh) groups than in the HTS (22âh) or RL (20âh) groups (Pâ=â0.0029). In conclusion, in an ovine model of septic shock, administration of HTL was associated with earlier onset impaired tissue perfusion and shorter survival time. These observations raise concerns about use of HTL in septic shock.