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Clinical Trial
. 2025 Apr 14;29(1):153.
doi: 10.1186/s13054-025-05374-y.

Exogenous lactate infusion (ELI) in traumatic brain injury: higher dose is better?

Paul Vespa  1 , Stephanie Wolahan  2 , Manuel Buitrago-Blanco  2 , Courtney Real  2 , Jesus Ruiz-Tejeda  3 , David L McArthur  2 , Jeffrey N Chiang  2 , Denes Agoston  4 , Thomas C Glenn  2
Affiliations
Clinical Trial

Exogenous lactate infusion (ELI) in traumatic brain injury: higher dose is better?

Paul Vespa et al. Crit Care. .

Abstract

Background/objective: Traumatic brain injury (TBI) is a life-threatening critical neurological injury resulting in widespread metabolic dysfunction in need of novel metabolic therapy. Exogenous lactate appears to improve brain metabolism, but the dose of lactate required remains uncertain. However, the ideal dose of lactate remains unclear. We present a comparison of low vs high dose exogenous sodium lactate infusion in a small cohort and the previous existing literature. We propose a systematic protocol to better study the question of dose-effect n in a future larger study.

Methods: We analyzed the metabolic and physiologic effects of various doses of exogenous sodium lactate infusion (ELI) in the existing published literature and our own, single center cohort of patients with coma from severe TBI. Low dose ELI targeting arterial lactate concentration of 2-3 mMol was compared with high dose ELI targeting 4-6 mM. Effects of ELI on brain metabolism and intracranial pressure (ICP) were reviewed. A precision high-dose protocol was piloted and results compared against the existing literature.

Results: Across various studies, metabolic response to ELI was variable and not consistently beneficial. High-dose ELI targeting arterial concentration of 4-6 mM resulted in consistent metabolic improvement and in ICP reduction (p < 0.01). The precision high dose protocol reliably resulted in higher arterial concentration.

Conclusions: High dose ELI appears to have more consistent beneficial effects on brain metabolism and intracranial pressure.

Trial registration: ClinicalTrials.gov ID NCT02776488. Date registered: 2016-05-17. Retrospectively Registered.

Keywords: Coma; Intracranial pressure; Lactate; Metabolic crisis; Oxidative metabolism; Traumatic brain injury.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: IRB approval of this study was grants by the UCLA Medical Institutional Review Board. Consent for publication: All authors provided consent for publication. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Timeline and key steps in the ELI infusion protocols used for low and high dose infusions
Fig. 2
Fig. 2
Changes in blood lactate concentration during left) fixed-low-dose ELI, with increase up to 3 times baseline, into the 2–3 mM range. On the right), precision titrated high dose infusion with increase up to 6 times baseline, into the 4–6 mM range. Grey shading indicates timing of ELI. CV = coefficient of variation (in grey box for emphasis)
See this image and copyright information in PMC

References

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    1. Xu Y, McArthur DL, Alger JR, Etchepare M, Hovda DA, Glenn TC, Huang S, Dinov I, Vespa PM. Early nonischemic oxidative metabolic dysfunction leads to chronic brain atrophy in traumatic brain injury. J Cereb Blood Flow Metab. 2010;30:883–94. - PMC - PubMed
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