The impact of hyperlactatemia on postoperative outcome after adult cardiac surgery

Kogan, Alexander; Preisman, Sergey; Bar, Alex; Sternik, Leonid; Lavee, Jacob; Malachy, Ateret; Spiegelstein, Dan; Berkenstadt, Haim; Raanani, Ehud

doi:10.1007/s00540-011-1287-0

Cited by 66 publications

(52 citation statements)

References 25 publications

(28 reference statements)

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“…Cardiac surgery patients often develop hyperlactatemia postoperatively [13], which may be affected by several factors, such as the type of surgery, patient body temperature and extracorporeal circulation. Elevated lactate levels in this patient category are also associated with postoperative mortality and a prolonged ICU stay [14,15]. A similar relation was observed for pediatric cardiac surgery patients [16].…”

Section: Introductionmentioning

confidence: 73%

Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery: a prospective observational study

et al. 2014

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IntroductionLactate is a marker of hypoperfusion and may be used for risk assessment in critically ill patients. Although evidence suggests that repeated lactate measurements are of clinical interest, how and when lactate should be analyzed is controversial. Intravascular microdialysis provides a novel method for the continuous monitoring of lactate, which may be clinically beneficial in critically ill patients.MethodsCirculating lactate levels were continuously monitored in 80 patients undergoing cardiac surgery using either a separate single-lumen microdialysis catheter or a triple-lumen central venous catheter with an integrated microdialysis function. The catheter was placed with the tip positioned in the superior vena cava. Arterial blood gas samples were taken every hour to obtain reference values, and the lactate levels were analyzed in a blood gas analyzer.ResultsA total of 1,601 paired microdialysis–arterial blood gas lactate samples were obtained. Bland-Altman analysis showed a bias (mean difference) ± limits of agreement (±1.96 SD) of 0.02 ± 0.42 mmol/L. The regression coefficient was 0.98 (P = 0.0001).ConclusionsCentral venous microdialysis is an accurate and reliable method for continuous blood lactate monitoring in patients undergoing cardiac surgery. The system may be useful for early lactate-guided therapy in critically ill patients.

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Section: Introductionmentioning

confidence: 73%

Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery: a prospective observational study

et al. 2014

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“…32,33 In the current trial, enrolled patients had two or more risk factors for hyperlactataemia and the overall incidence of hyperlactataemia was 60% as we expected, which was higher than the results of previous studies (approximately 20%). [2][3][4][5] Patients developing hyperlactataemia showed higher incidences of renal failure and reoperation and longer durations of ventilator care, ICU and hospital stay regardless of the group in the current trial (data not 560 Roh et al shown). These results implicate the value of lactate concentration as a predictor of poor prognosis.…”

Section: Discussionmentioning

confidence: 62%

“…1 It is frequently encountered in cardiac surgery requiring cardiopulmonary bypass (CPB) and has been demonstrated to be associated with adverse outcomes. [2][3][4][5] Risk factors for hyperlactataemia in cardiac surgery include complex surgery, longer duration of CPB, haemodynamic instability, use of vasoconstrictors and hyperglycaemia. [2][3][4] Inherent to the use of CPB, various factors including insufficient pump flow, excessive haemodilution and ischaemia-reperfusion injury are known to contribute to increased myocardial and splanchnic lactate production and compromised hepato-splanchnic lactate extraction.…”

Section: Introductionmentioning

confidence: 99%

Effect of glucose–insulin–potassium on hyperlactataemia in patients undergoing valvular heart surgery

Roh

Shim

Song

et al. 2015

European Journal of Anaesthesiology

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“…[86] Consequently, transient hemodynamic improvement may be outweighed by adverse events related to arrhythmias, hyperglycemia, lactic acidosis and beta-adrenergic receptor desentitization. [87,88] A mismatch between increased myocardial oxygen demand and oxygen delivery may further amplify myocardial reperfusion injuries. Increasing levels of catecholamines have also been associated with bacterial growth, increased germ virulence, and biofilm formation.…”

Section: Indications and Risks Of Inotropic Drugsmentioning

confidence: 99%

Clinical Review: Management of weaning from cardiopulmonary bypass after cardiac surgery

Licker¹,

Diaper²,

Cartier³

et al. 2012

Ann Card Anaesth

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A sizable number of cardiac surgical patients are difficult to wean off cardiopulmonary bypass (CPB) as a result of structural or functional cardiac abnormalities, vasoplegic syndrome, or ventricular dysfunction. In these cases, therapeutic decisions have to be taken quickly for successful separation from CPB. Various crisis management scenarios can be anticipated which emphasizes the importance of basic knowledge in applied cardiovascular physiology, knowledge of pathophysiology of the surgical lesions as well as leadership, and communication between multiple team members in a high-stakes environment. Since the mid-90s, transoesophageal echocardiography has provided an opportunity to assess the completeness of surgery, to identify abnormal circulatory conditions, and to guide specific medical and surgical interventions. However, because of the lack of evidence-based guidelines, there is a large variability regarding the use of cardiovascular drugs and mechanical circulatory support at the time of weaning from the CPB. This review presents key features for risk stratification and risk modulation as well as a standardized physiological approach to achieve successful weaning from CPB.

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The impact of hyperlactatemia on postoperative outcome after adult cardiac surgery

Abstract: Hyperlactatemia is common after cardiac surgery. Maximal lactate threshold ≥4.4 mmol/l in the first 10 h after operation accurately predicts postoperative mortality.

Cited by 66 publications

References 25 publications

Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery: a prospective observational study

Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery: a prospective observational study

Effect of glucose–insulin–potassium on hyperlactataemia in patients undergoing valvular heart surgery

Clinical Review: Management of weaning from cardiopulmonary bypass after cardiac surgery

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