Metabolic Acidosis Assessment in High-Risk Surgeries

Silva, J. M.; Oliveira, Ana-Paula M.; Nogueira, F.; Vianna, P. M.; Amêndola, Cristina Prata; Carmona, Maria José Carvalho

doi:10.1097/01.sa.0000521773.30207.e8

Cited by 3 publications

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“…As mentioned above, HL and metabolic acidosis are known to be associated with poor outcomes in surgical patients. [9][10][11][12][13][14][15] The pathophysiology of the hyperlactatemic state is primarily one of hypoperfusion, resulting in anaerobic metabolism and lactic acid production. The main factors leading to organ dysoxia during CPB are the haemodilution degree and a low peripheral oxygen delivery (Do 2 ).…”

Section: Discussionmentioning

confidence: 99%

Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-term outcome

et al. 2020

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Introduction: Lactate, a product of anaerobic metabolism, is a biomarker and indicator for tissue hypoperfusion and oxygen debt. An elevated blood lactate level has been associated with poor outcome in many clinical conditions, including cardiac surgery. Nevertheless, debate exists regarding which blood lactate concentration is most indicative of poor outcomes. We evaluate the impact of hyperlactatemia, defined as a peak arterial blood concentration ⩾2.0 mmol/L during cardiopulmonary bypass, on surgical results with a focus on long-term outcome. Methods: We reviewed 1,099 consecutive adult patients who underwent cardiac surgery on pump. The patients were divided into two groups based on the presence or not of hyperlactatemia. Pre- and intraoperative risk factors for hyperlactatemia were identified, and the postoperative outcome of patients with or without hyperlactatemia was compared. Results: Hyperlactatemia was present in 372 patients (33.8%). Factors independently associated with hyperlactatemia were urgent/emergency procedure, cardiopulmonary bypass duration and aortic cross-clamp time. Patients with hyperlactatemia had significantly higher rate of prolonged mechanical ventilation time, in-hospital stay and requirement of inotropes and intra-aortic balloon pump support (p < 0.001). Operative (30-day) mortality was higher in the group of patients with hyperlactatemia (7.8% vs. 1.1%; p < 0.001). Kaplan–Meier curve showed worse long-term survival (mean follow-up: 4.02 ± 1.58 years) in patients with hyperlactatemia. Conclusion: Hyperlactatemia during cardiopulmonary bypass has a significant association with postoperative morbidity and mortality. Correction of risk factors for hyperlactatemia, together with prompt detection and correction of this condition, may control complications and improve outcome.

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Section: Discussionmentioning

confidence: 99%

Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-term outcome

et al. 2020

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“…In addition, maintaining homeostasis of electrolytes, glucose, and acid-base balance are crucial issues in surgical patients. Perioperative disturbances in sodium, [8][9][10] potassium, 11,12 and glucose [13][14][15] concentrations, as well as in acid-base balance, 16 have been shown to contribute to morbidity and mortality. In vitro studies indicated that in the supernatant of aging RBCs potassium and lactate accumulate while sodium, base excess (BE), and pH decrease with extending RBC storage periods.…”

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confidence: 99%

Duration of storage influences the hemoglobin rising effect of red blood cells in patients undergoing major abdominal surgery

et al. 2018

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“…Previous studies addressing postoperative acid-base balance and outcome have focused primarily on metabolic acidosis while de ning this as a decrease in BE, with decreased BE due to hyperlactatemia associated with increased mortality (Silva et al 2016;Rutherford et al 1992). In our study we used LOS as outcome measure as well as the occurrence of major morbid events (e.g.…”

Section: Discussionmentioning

confidence: 99%

The hidden secrets of a neutral pH – Blood-Gas-Analysis of postoperative patients according to the Stewart approach

Janssen

Fessem

Ris

et al. 2020

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Background: The superiority of either the traditional or Stewart based approach to acid-base balance has focused primarily on analyzing metabolic acidemia, with little attention given to patients with neutral pH. In this study, we evaluate metabolic disturbances in patients in the immediate postoperative period focusing on patients with neutral pH, while comparing the Stewart and traditional approach. Methods: We conducted a single center retrospective observational cohort study. Over a 17 month period, data on arterial blood gas analysis, electrolytes and albumin on the morning after surgery were retrieved from patients admitted to the postsurgical high dependency unit (HDU). Albumin corrected anion gap (AG), apparent (SIDa) and effective strong ion difference (SIDe) and strong ion gap (SIG) were calculated.Results: Out of 1207 HDU admissions, 400 cases had a complete set of laboratory-data including albumin of which 281 presented with neutral pH (7.35 ≤ pH ≤ 7.45), 64 with acidemia (pH < 7.35) and 55 with alkalemia (pH > 7.45). In pH neutral patients the following acidifying disturbances were found: SIDa was lowered in 101 (36%), SIG was raised in 60 (21%). Base excess (BE) was decreased in 16 (6%) and corrected AG raised in 107 (38%). The alkalizing effect of hypoalbuminemia was present in 137 (49%). Out of 134 cases with normal BE and corrected AG, SIDa was lowered in 58 (43%). Out of 136 cases with normal SIDa and SIG, none had lowered BE and 28 increased AG (21%). Length of stay was significantly longer in patients with hypoalbuminemia, lowered SIDa and increased corrected AG, but not decreased BE (Hypoalbuminemia: 16 days vs. 10 days, P < 0.001. Low SIDa: 15 days vs. 12 days, P = 0.015. Increased AG: 16 days vs. 11 days, P < 0.001. Low BE: 14 days vs. 13 days, P = 0.736).Conclusions: Metabolic disturbances, characterized mainly by the presence of lowered SIDa, increased AG and hypoalbuminemia, are frequent in our population with apparent neutral acid-base balance based on pH and base excess. These changes on the morning after surgery are associated with increased length of stay.

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Metabolic Acidosis Assessment in High-Risk Surgeries

Cited by 3 publications

References 0 publications

Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-term outcome

Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-term outcome

Duration of storage influences the hemoglobin rising effect of red blood cells in patients undergoing major abdominal surgery

The hidden secrets of a neutral pH – Blood-Gas-Analysis of postoperative patients according to the Stewart approach

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