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The Effect of Early Mild Permissive Hyperlactatemia Strategy on Patients with Acute Intracranial Hypertension Induced by Spontaneous Intracerebral Hemorrhage

Author(s): Chen Sheng-long, Wang Zhong-hua, Liu Xin-qiang, Yang Ren-qiang, Zeng Hong-ke, Chai Yun-fei

Background: Dehydrating therapy to relieve brain edema is one of main methods to treat acute intracranial hypertension (ICH) after spontaneous cerebral hemorrhage. However, little is known regarding how much the negative fluid balance should be and indications of optimal fluid status. This study was to investigate whether mild permissive hyperlactatemia within initial 3-day is an available indicator guiding fluid management in patients with acute ICH.

Methods: Adult patients of spontaneous cerebral hemorrhage with ICH admitted to the ICU and receiving dehydrating agents were retrospectively analyzed. The daily serum lactate concentration was collected over the first 3 days after admission. According to level of serum lactate, patients were divided into three groups (Normal-lactate group: <2 mmol/L, Mild-lactate group: 2-3.5 mmol/L, High-lactate group: >3.5 mmol/L respectively). And the main endpoint of this study was the 30-day mortality following ICU admission.

Results: The mortality rate at 30 days in the high-lactate group patients was significantly higher than that in the other two groups (normal-group and mild-lactate group), (26.4% vs (16.5% and 10.9%), P<0.01). Furthermore, compared with the normal-lactate group, the 30-day mortality rate was significantly lower (10.9% vs 16.5%, P<0.01), the Glasgow Coma (GCS) Score at 7-day was better (10.8 ± 3.8 vs 8.3 ± 2.4, P=0.021), and the length of ICU stay was shorter (14.2 ± 7.3 vs 16.7 ± 8.6 d, P=0.015) in the mild-lactate group.

Conclusions: In this retrospective cohort, mild permissive hyperlactatemia (2-3.5 mmol/L) over the first 3 days as a reference range that can be used to optimize fluid management in patients with ICH who accept dehydrating therapy.

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