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Ranucci, Marco; Toffol, Barbara De; Isgrò, Giuseppe; Romitti, Federica; Conti, Daniela; Vicentini, Maira

doi:10.1186/cc5113

Cited by 156 publications

(64 citation statements)

References 23 publications

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“…The same association was found for the peak BL value during CPB [18], [19], that is likely to be associated with the BL value at the admission in the ICU. Different studies proposed different cut-off values, ranging from 2 mmol/L [17] to 3 mmol/L [7], [19] or 4 mmol/L [18].…”

Section: Discussionsupporting

confidence: 72%

Intensive Care Unit Admission Parameters Improve the Accuracy of Operative Mortality Predictive Models in Cardiac Surgery

et al. 2010

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BackgroundOperative mortality risk in cardiac surgery is usually assessed using preoperative risk models. However, intraoperative factors may change the risk profile of the patients, and parameters at the admission in the intensive care unit may be relevant in determining the operative mortality. This study investigates the association between a number of parameters at the admission in the intensive care unit and the operative mortality, and verifies the hypothesis that including these parameters into the preoperative risk models may increase the accuracy of prediction of the operative mortality.Methodology929 adult patients who underwent cardiac surgery were admitted to the study. The preoperative risk profile was assessed using the logistic EuroSCORE and the ACEF score. A number of parameters recorded at the admission in the intensive care unit were explored for univariate and multivariable association with the operative mortality.Principal FindingsA heart rate higher than 120 beats per minute and a blood lactate value higher than 4 mmol/L at the admission in the intensive care unit were independent predictors of operative mortality, with odds ratio of 6.7 and 13.4 respectively. Including these parameters into the logistic EuroSCORE and the ACEF score increased their accuracy (area under the curve 0.85 to 0.88 for the logistic EuroSCORE and 0.81 to 0.86 for the ACEF score).ConclusionsA double-stage assessment of operative mortality risk provides a higher accuracy of the prediction. Elevated blood lactates and tachycardia reflect a condition of inadequate cardiac output. Their inclusion in the assessment of the severity of the clinical conditions after cardiac surgery may offer a useful tool to introduce more sophisticated hemodynamic monitoring techniques. Comparison between the predicted operative mortality risk before and after the operation may offer an assessment of the operative performance.

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Section: Discussionsupporting

confidence: 72%

Intensive Care Unit Admission Parameters Improve the Accuracy of Operative Mortality Predictive Models in Cardiac Surgery

et al. 2010

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“…The phenomenon of increased blood glucose and blood lactate levels during the perioperative period is often observed, even in patients with hyperglycemia (1–5) 60–70% (4) and lactic acidosis (6–8) 10–20% (9,10). This increases the incidence of postoperative complications and mortality (1,8,9,11).…”

Section: Introductionmentioning

confidence: 99%

Change in the perioperative blood glucose and blood lactate levels of non-diabetic patients undergoing coronary bypass surgery

Shen

et al. 2013

Experimental and Therapeutic Medicine

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In the present study, a retrospective analysis of the trends and factors affecting blood glucose and blood lactate levels was carried out for non-diabetic adult patients who had undergone coronary artery bypass graft (CABG) surgery. Between October 2009 and October 2011, 200 non-diabetic adult patients undergoing CABG surgery were examined. Glucose and lactic acid levels were observed successively during surgery [following the induction of anesthesia, cardio-pulmonary bypass (CPB), aortic cross-clamping and aortic stop flow infusion], at the end of surgery and after surgery [1, 6, 12, 24 and 48 h after admission to the intensive care unit (ICU)]. The results of blood gas analyses and other related indicators for trend analysis were investigated. The peak blood glucose and blood lactate levels during CPB, as well as other CPB factors, were also analyzed. Following aortic cross-clamping, intraoperative blood glucose and blood lactate levels increased gradually with increasing operative time. Postoperatively, blood glucose and blood lactate levels continued to rise. Blood glucose and blood lactic acid levels during CPB were positively correlated. The blood glucose and blood lactate levels of non-diabetic adult patients undergoing CABG increased gradually with operative time following aortic cross-clamping. Moreover, blood glucose and blood lactate levels were positively correlated with the duration of CPB and duration of aortic cross-clamping.

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“…Hyperlactatemia was observed in a substantial proportion of patients who had been operated on under extracorporeal circulation in a Russian study which included 270 patients after cardiac surgery (Bakanov et al, 2009). Ranucci et al (2006) reported the rate of patients with hyperlactatemia during cardiopulmonary bypass (CPB) as being relatively low (5.7%) when they measured progressive hyperlactatemia during the procedure (excluding 30 patients who had preexisting hyperlactatemia). The overall incidence of hyperlactatemia was 11.4%.…”

Section: The Prevalence and Incidence Of Postoperative Hyperlactatemiamentioning

confidence: 99%

“…Urgent or emergency surgery is usually performed for patients who are hemodynamically unstable, and so the preoperative lactate values might have already been abnormal in some of them. Non-pre-existing hyperlactatemia during CPB for cardiac operations in adults is favored by the preoperative risk profile (high serum creatinine values and active endocarditis) and by prolonged (> 96 minutes) CPB times, in addition to being associated with hyperglycemia (Ranucci et al, 2006). Patients with a blood lactate level of 4.0 mmol/L (36 mg/dL) or higher were older and were more often females.…”

Section: Preoperativementioning

confidence: 99%

The Physiology and the Clinical Significance of Postoperative Hyperlactatemia After Pediatric Cardiac Surgery

Molina-Hazan¹,

Paret²

2012

Perioperative Considerations in Cardiac Surgery

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Cited by 156 publications

References 23 publications

Intensive Care Unit Admission Parameters Improve the Accuracy of Operative Mortality Predictive Models in Cardiac Surgery

Intensive Care Unit Admission Parameters Improve the Accuracy of Operative Mortality Predictive Models in Cardiac Surgery

Change in the perioperative blood glucose and blood lactate levels of non-diabetic patients undergoing coronary bypass surgery

The Physiology and the Clinical Significance of Postoperative Hyperlactatemia After Pediatric Cardiac Surgery

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