Monitoring of the Progression of the Perioperative Serum Lactate Concentration Improves the Accuracy of the Prediction of Acute Mesenteric Ischemia Development After Cardiovascular Surgery

Mothes, Henning; Wickel, Jana; Sponholz, Christoph; Kaluza, Mirko; Zanow, J.; Doenst, Torsten

doi:10.1053/j.jvca.2021.02.007

Cited by 6 publications

(6 citation statements)

References 42 publications

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“…The range of these values was 183.3 ± 153 IU/L to 3890 ± 2443 12,15 . Three studies provided values at given time periods postoperatively 33 . Therefore, we utilized the lactate value provided at 24 h (in these studies, all lactate values postcardiac surgery were deemed statistically significant).…”

Section: Resultsmentioning

confidence: 99%

Predicting outcomes of mesenteric ischemia postcardiac surgery: A systematic review

Kayali

Sarodaya

Shah

et al. 2022

Journal of Cardiac Surgery

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Objective This systematic review aims to identify predictors of outcomes of mesenteric ischemia in patients following cardiac surgery. Methods A comprehensive literature search was done on EMBASE, PubMed, Ovid MEDLINE, and SCOPUS using keywords relating to bowel ischemia and cardiac surgery. Database search results were screened by at least two authors and 32 articles were selected for inclusion in this review. Results Data on 1907 patients were analyzed. The mean age was 70.0 ± 2.99 years and the prevalence of bowel ischemia was 1.74%. Advanced age was a significant risk factor. 63.16% of patients reported were men, and 58.4% of patients died in hospital. There was heterogeneity in the reported significance of the following preoperative risk factors: hypertension, smoking status, type 2 diabetes mellitus, end‐stage renal disease, preoperative left ventricular ejection fraction <35%. Cardiopulmonary bypass (CPB) time, preoperative/operative intra‐aortic balloon pump (IABP) support, and inotrope usage were significantly associated with the development of mesenteric ischemia; however, other intraoperative factors including the type of cardiac surgery and duration of aortic cross‐clamping had varying levels of reported significance. There were discrepancies in the reported significance of leukocytosis and metabolic acidosis (pH <7.3) as postoperative markers. Postoperative vasopressor use, prolonged ventilation time, and elevation in lactate, transaminases, creatinine, and intestinal fatty acid‐binding protein (IFABP) levels were found to be strongly associated with bowel ischemia. Conclusion This systematic review found the strongest associations of mesenteric ischemia postcardiac surgery to be advanced age, CPB time, rise in lactate, transaminases, creatinine, and IFABP. IABP support, vasopressor, and inotrope use as well as prolonged ventilation were strongly linked too.

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Section: Resultsmentioning

confidence: 99%

Predicting outcomes of mesenteric ischemia postcardiac surgery: A systematic review

Kayali

Sarodaya

Shah

et al. 2022

Journal of Cardiac Surgery

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“…A lactate level higher than 3 mmol/l can discriminate between survivors and non-survivors after cardiac surgery 1,6 and is associated with four-fold increased risk of development of mesenteric ischemia. 3 In the present study, two-thirds of the included patients in each study group had peak lactate levels higher than 3 mmol/l during the first 24 hours after surgery. The mortality rate was similar among the two groups.…”

Section: Discussionmentioning

confidence: 96%

“…30 Few patients in the placebo and norepinephrine groups (7% in each group) experienced postoperative vasoplegia. There is no consensus on the definition of postcardiotomy vasoplegia in the previous studies; the authors in the present study used the definition considered by Monaco et al 3…”

Section: Discussionmentioning

confidence: 99%

“…1 It is typically a symptom of tissue hypoperfusion. 2 It might be associated with the prevalence of postoperative acute mesenteric ischemia 3 and renal failure, 4 prolonged intensive care unit (ICU) and hospital stay, 4 and increased 30-day mortality. 5,6 Several predictors for hyperlactatemia after cardiac surgery have been identified, including prolonged cardiopulmonary bypass (CPB), preoperative serum creatinine, active endocarditis, the peak blood glucose level, and low oxygen delivery during CPB.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of norepinephrine infusion during cardiopulmonary bypass on perioperative changes in lactic acid level (Norcal)

et al. 2022

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Introduction Hyperlactatemia, a problem reported in up to 30% of cardiac surgery patients, results from excessive production of or decreased clearance of lactate. It is typically a symptom of tissue hypoperfusion and may be associated with the prevalence of postoperative acute mesenteric ischemia and renal failure, or prolonged intensive care unit (ICU) and hospital stay, and increased 30-day mortality. Methods and measurements Eighty cardiac surgery patients using cardiopulmonary bypass (CPB) were randomly assigned into either a placebo (n = 39) or norepinephrine 0.05–0.2 µg/kg/min (n = 41) as well as norepinephrine boluses during CPB to maintain mean arterial blood pressure (MAP) at 65 to 80 mm Hg. Patient assignments were done after receiving ethical approval to proceed. The primary result was the perioperative changes in lactic acid level. Secondary findings were also recorded, including hemodynamic variables, the incidence of vasoplegia, intraoperative hypotension, myocardial ischemia, the need for vasopressor support, postoperative complications, and mortality. Results The peak levels and perioperative changes in blood lactate during the first 24 postoperative hours, the number of patients who experienced early hyperlactatemia on admission to the ICU (Placebo: 46.2%, Norepinephrine: 51.2%, p = .650), vasoplegia, hemodynamic changes, incidences of intraoperative hypotension, myocardial ischemia, postoperative complications, and mortality rates were similar in the two groups. Patients in the norepinephrine group received lower intraoperative rescue norepinephrine boluses to maintain the target MAP (p = .039) and had higher MAP values during the CPB and intraoperative blood loss [mean difference [95% confidence interval]; 177 [20.9–334.3] ml, p = .027]. Conclusion norepinephrine and placebo infusions during the CPB with the maintenance of MAP from 65 to 80 mmHg had comparative effects on the changes in blood lactate and incidence of vasoplegia after cardiac surgery. Norepinephrine infusion maintained higher MAP values during the CPB.

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l-lactate kinetics after abdominal aortic surgery and intestinal ischemia – An observational cohort study

Novotný

Staffa

Tomandl

et al. 2022

International Journal of Surgery

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Monitoring of the Progression of the Perioperative Serum Lactate Concentration Improves the Accuracy of the Prediction of Acute Mesenteric Ischemia Development After Cardiovascular Surgery

Cited by 6 publications

References 42 publications

Predicting outcomes of mesenteric ischemia postcardiac surgery: A systematic review

Predicting outcomes of mesenteric ischemia postcardiac surgery: A systematic review

Effects of norepinephrine infusion during cardiopulmonary bypass on perioperative changes in lactic acid level (Norcal)

l-lactate kinetics after abdominal aortic surgery and intestinal ischemia – An observational cohort study

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