Effects of lactate-based therapies on intracranial pressure and brain metabolism of patients with acute brain injury: a systematic review.
Level 3 - non-randomized controlled study
systematic review including preclinical studies and mixed clinical designs rather than exclusively randomized controlled trials
PubMed 41896992 · doi:10.1186/s13054-026-05973-3
What was done
A systematic review was conducted evaluating preclinical and clinical studies on exogenous sodium lactate administration across acute brain injury conditions (traumatic brain injury, ischemic stroke, and cardiac arrest). Authors synthesized 24 studies (12 preclinical, 12 clinical) examining intracranial pressure control, cerebral metabolism, cerebral perfusion and oxygenation, systemic hemodynamics, safety, and functional recovery.
What was found
No quantitative data, pooled effect sizes, or confidence intervals were reported in the abstract. Sodium lactate reduced intracranial pressure across most models and was reported as at least as effective and safe as mannitol or hypertonic saline in clinical settings, with multiple studies reporting improved systemic hemodynamic tolerance. Exogenous lactate was taken up and oxidized by injured brain tissue, but metabolic benefits varied based on preserved oxidative metabolism, baseline status, timing, and dose. Functional outcome data were limited.
Why it matters
Sodium lactate represents an alternative to standard osmotherapy that may control elevated intracranial pressure while acting as a cerebral energy substrate. These findings suggest clinical utility may depend on preserved oxidative capacity, pointing to a need for targeted patient selection and metabolic monitoring.
Limits
The abstract reports no numerical estimates or meta-analytic figures. Half of the included evidence is preclinical (12 of 24 studies), patient cohorts spanned heterogeneous injury etiologies, and evidence evaluating meaningful functional and cognitive recovery remains sparse.
Cited by
- context Infusing traumatic brain injury (TBI) patients with sodium lactate improves TBI outcomes as measured by Glasgow scores.