• Carole Ichai, Guy Armando, Jean-Christophe Orban, Frederic Berthier, Laurent Rami, Corine Samat-Long, Dominique Grimaud, and Xavier Leverve.
• Faculté de Médecine and CHU de Nice, Service de Réanimation, Hôpital Saint-Roch, Nice Cedex 1, France. ichai@unice.fr
• Intensive Care Med. 2009 Mar 1;35(3):471-9.

ObjectivesTraumatic brain injury (TBI) is still a major cause of mortality and morbidity. Recent trials have failed to demonstrate a beneficial outcome from therapeutic treatments such as corticosteroids, hypothermia and hypertonic saline. We investigated the effect of a new hyperosmolar solution based on sodium lactate in controlling raised intracranial pressure (ICP).Design And SettingProspective open randomized study in an adult ICU.PatientsThirty-four patients with isolated severe TBI (Glasgow Coma Scale Measurements And ResultsCompared to mannitol, the effect of the lactate solution on ICP was significantly more pronounced (7 vs. 4 mmHg, P = 0.016), more prolonged (fourth-hour-ICP decrease: -5.9 +/- 1 vs. -3.2 +/- 0.9 mmHg, P = 0.009) and more frequently successful (90.4 vs. 70.4%, P = 0.053).ConclusionAcute infusion of a sodium lactate-based hyperosmolar solution is effective in treating intracranial hypertension following traumatic brain injury. This effect is significantly more pronounced than that of an equivalent osmotic load of mannitol. Additionally, in this specific group of patients, long-term outcome was better in terms of GOS in those receiving as compared to mannitol. Larger trials are warranted to confirm our findings.

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