Lactate level during cardiopulmonary bypass as a predictor of postoperative outcomes in adult patients undergoing cardiac surgery

Noguchi, Satoko; Saito, Junichi; Hashiba, Eiji; Kushikata, Tetsuya; Hirota, Kazuyoshi

doi:10.1186/s40981-016-0064-3

Cited by 14 publications

(20 citation statements)

References 19 publications

(29 reference statements)

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“…Ringer's lactate is commonly used in pump prime but many studies have proved its role in causing lactic acidosis. [ 7 8 ] The electrolyte composition of Ringer's lactate is significantly different from that of plasma. Ringer's lactate contains 131 mEq/L sodium ions, 111 mEq/L chloride ions, potassium content is 5 mEq/L, calcium content is 2 mEq/L, and lactate content of 28 mEq/L.…”

Section: Introductionmentioning

confidence: 99%

Comparison of ringer's lactate and plasmalyte-a as cardiopulmonary bypass prime for bypass associated acidosis in valve replacement surgeries

Kumar

2021

Annals of Cardiac Anaesthesia

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Introduction: A wide range of acid base fluctuations are seen during Cardiopulmonary bypass (CPB) and the development of metabolic acidosis is well recognized. We conducted a study tocompare the metabolic effects of Ringer lactate and Plasmalyte-A as CPB prime in causing bypass associated acidosis in valve replacement surgeries. Methods: We performed a prospective, randomized controlled study on a total of 80 adult patients undergoing CPB for valvular heart surgeries. The patients were randomized into two groups: Group I (Ringer Lactate) and Group II (Plasmalyte-A). Arterial blood samples were taken before initiating CPB, 30 minutes after starting CPB, then every half hourly till termination of CPB and after half an hour stay in the ICU post operatively to analyze primarily H+ ions, bicarbonates, lactate and strong ion difference. Results and Discussion: The results were analyzed in a quantitative manner. In Ringer Lactate group, during CPB, there was reduction in pH from 7.428 ± 0.029 at T1 to 7.335 ± 0.06 ( P < 0.01) and 7.358 ± 0.06 ( P < 0.01) at T2 and T3 respectively. Mean bicarbonates decreased in Ringer Lactate group during CPB from 24.28 ± 1.65 mEq/L at T1 to 20.98 ± 2.97 mEq/L at T2 ( P < 0.01). In Plasmalyte-A group, mean pH, bicarbonate, strong ion difference (SID) were comparable at all time intervals ( P > 0.05). In Ringer Lactate group, maximum surge in mean blood lactate levels was seen from 0.85 ± 0.35 mmol/l at T1 to 4.29 ± 1.78 mmol/L ( P < 0.01) and 4.17 ± 1.28 mmol/L ( P < 0.01) at T2 and T3, respectively. Such surge was not seen in Plasmalyte-A group. The mean SID decreased during the CPB in Ringer Lactate group from 41.102 mEq/L at T1 to 35.66 mEq/L ( P = 0.033) at T2 implying metabolic acidosis. Numbered patients having hypotension and arrhythmias were also higher in Ringer Lactate group again indicating higher acidosis. Conclusion: The different composition of Plasmalyte-A and Ringer Lactate have different metabolic implications for patients undergoing cardiac surgery. Patients who received Plasmalyte-A as cardiopulmonary bypass prime developed less metabolic acidosis. Hence we conclude that Plasmalyte-A is the preferred cardiopulmonary bypass prime in adult patients undergoing valve replacement surgeries.

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Section: Introductionmentioning

confidence: 99%

Comparison of ringer's lactate and plasmalyte-a as cardiopulmonary bypass prime for bypass associated acidosis in valve replacement surgeries

Kumar

2021

Annals of Cardiac Anaesthesia

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“…An increase in blood lactate levels could be observed during and/or after cardiac surgery. Such an increase has been previously reported to be associated with a greater incidence of postoperative morbidity and mortality in adult, 3,[7][8][9][10]14,17,18 as well as in the paediatric cardiac surgical patients. 24 A perioperative hyperlactatemia is classically defined in the literature as mild to moderate for values ranging from 2 to 4 mmol L −1 and is considered as severe when levels increase above 4 mmol L −1 .…”

Section: Discussionmentioning

confidence: 74%

“…1,3–5 Although the increase in blood lactate level during cardiac surgery may have multifactorial origin including aerobic and anaerobic lactate production, 6 high perioperative levels have been reported to be associated with poor outcomes. 3,7–13 A major limit of these studies was that patients included were dichotomised into only two groups with clinically irrelevant cut-offs. 3,7,8,10,14 Moreover, most of these studies considered only early postoperative lactate levels upon patients’ arrival in the intensive care unit (ICU) but not the intraoperative ones.…”

Section: Introductionmentioning

confidence: 99%

“…3,7,8,10,14 Moreover, most of these studies considered only early postoperative lactate levels upon patients' arrival in the intensive care unit (ICU) but not the intraoperative ones. 9,10,12,[15][16][17][18] The literature strongly suggests that haemodynamic optimisation should be performed promptly during the surgery to improve outcome. 19 Thus, tissue hypoperfusion should be rapidly detected by measuring intraoperative blood lactate levels.…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative changes in blood lactate levels are associated with worse short-term outcomes after cardiac surgery with cardiopulmonary bypass

et al. 2019

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Background: A high perioperative blood lactate level has been reported to be associated with poor outcomes after cardiac surgery. More than isolated peaks of lactate values, it should be more interesting to take into account changes in intraoperative blood lactate level (∆Lact). This large-scale retrospective study evaluated the relationship between ∆Lact and overall intensive care unit morbidity and 30-day all-cause mortality. Methods: Perioperative data from consecutive patients undergoing on-pump cardiac surgery between September 2010 and June 2016 were retrospectively analysed through our institutional database including clinical, transfusion and laboratory test results implemented prospectively by physicians. Blood lactate levels were initially measured after induction of anaesthesia (baseline) and periodically during the surgery. The ∆Lact was defined as the difference between the highest intraoperative blood lactate and the baseline lactate level and offered the opportunity to stratify patients into four subgroups: ⩽0, 0.1-0.9, 1-1.9 and ⩾2 mmol L−1. Results: From the 7,795 patients found eligible during the study period, 7,447 patients were analysed. The median ∆Lact of our patients was 0.6 (0.3-1) mmol L−1. Most of the studied patients (65.9%) exhibited a ∆Lact between 0.1 and 0.9 mmol L−1. A concentration-dependent relationship was observed between ∆Lact and intensive care unit morbidity and 30-day mortality. After adjustment for co-variables, all ∆Lact > 0 was associated with an increase in overall intensive care unit morbidity. An independent relationship was also found between ∆Lact and 30-day mortality as of a 1 mmol L−1 increase. Conclusion: Our results suggest that ∆Lact is associated with poor short-term outcomes in adult cardiac surgical patients.

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“…Cardiac surgery is relevant due to its relationship with cardiac biochemical processes during extracorporeal circulation (ECC), in which the presence of elevated lactatemia is a predictor of postoperative outcomes [ 6 ]. In fact, levels higher than 4.4 mmol/L are related to an increased stay in the ICU and general ward [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

et al. 2020

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Introduction Hyperlactatemia occurs during or after extracorporeal circulation in the form of lactic acidosis, increasing the risk of postoperative complications and the mortality rate. The aim of this study was to evaluate whether continuous high-volume hemofiltration with volume replacement through a polyethersulfone filter during the extracorporeal circulation procedure decreases postoperative lactatemia and its consequences. Materials and methods This was a randomized controlled trial. Patients were randomly divided into two groups of 32: with or without continuous high-volume hemofiltration through a polyethersulfone membrane. Five patients were excluded from each group during the study period. The sociodemographic characteristics, filter effects, and blood lactate levels at different times during the procedure were evaluated. Secondary endpoints were studied, such as the reduction in the intubation time and time spent in ICU. Results Lactatemia measurements performed during the preoperative and intraoperative phases were not significantly different between the two groups. However, the blood lactate levels in the postoperative period and at 24 hours in the intensive care unit showed a significant reduction and a possible clinical benefit in the hemofiltered group. Following extracorporeal circulation, the mean lactate level was higher (difference: 0.77 mmol/L; CI 0.95: 0.01–1.53) in the nonhemofiltered group than in the hemofiltered group (p<0.05). This effect was greater at 24 hours (p = 0.019) in the nonhemofiltered group (difference: 1.06 mmol/L; CI 0.95: 0.18–1.93) than in the hemofiltered group. The reduction of lactatemia is associated with a reduction of inflammatory mediators and intubation time, with an improvement in liver function. Conclusions The use and control of continuous high-volume hemofiltration through a polyethersulfone membrane during heart-lung surgery could potencially prevent postoperative complications. The reduction of lactatemia implied a reduction in intubation time, a decrease in morbidity and mortality in the intensive care unit and a shorter hospital stay.

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Lactate level during cardiopulmonary bypass as a predictor of postoperative outcomes in adult patients undergoing cardiac surgery

Cited by 14 publications

References 19 publications

Comparison of ringer's lactate and plasmalyte-a as cardiopulmonary bypass prime for bypass associated acidosis in valve replacement surgeries

Comparison of ringer's lactate and plasmalyte-a as cardiopulmonary bypass prime for bypass associated acidosis in valve replacement surgeries

Intraoperative changes in blood lactate levels are associated with worse short-term outcomes after cardiac surgery with cardiopulmonary bypass

Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

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