Neuroanesthesia & neurocritical care
Effects of lactate-based therapies on intracranial pressure and brain metabolism of patients with acute brain injury: a systematic review
Authors' conclusion
Sodium lactate is an effective therapy for intracranial hypertension and may offer additional metabolic and systemic advantages in ABI patients under specific conditions.
Study context
- Population
- Acute brain injury, incl. TBI, ischemic stroke and cardiac arrest (preclinical and clinical)12 preclinical, 12 clinical studies
- Comparison
- Exogenous sodium lactate vs conventional osmotherapy
- Outcome
- ICP control
Pooled result
As reported in the abstract
- Sodium lactate effective in reducing intracranial pressure (ICP) across most models
- At least as effective and safe as mannitol or hypertonic saline in clinical settings
Further pooled results
Systemic hemodynamics
- Several studies reported improved systemic hemodynamic tolerance vs conventional osmotherapy
Cerebral metabolism
- Lactate taken up and oxidized by injured brain; metabolic benefits inconsistent, dependent on preserved oxidative metabolism, baseline metabolic status, timing and dose
Functional outcome
- Limited data suggesting potential cognitive and neurological benefits in experimental and selected clinical settings
Original publication
Effects of lactate-based therapies on intracranial pressure and brain metabolism of patients with acute brain injury: a systematic review. Crit Care. Published 27 March 2026. doi:10.
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