Lactate Elevation During and After Major Cardiac Surgery in Adults: A Review of Etiology, Prognostic Value, and Management

Abstract

Elevated lactate is a common occurrence after cardiac surgery. This review summarizes the literature on the complex etiology of lactate elevation during and after cardiac surgery, including considerations of oxygen delivery, oxygen utilization, increased metabolism, lactate clearance, medications and fluids, and postoperative complications. Second, the association between lactate and a variety of outcomes are described, and the prognostic role of lactate is critically assessed. Despite the fact that elevated lactate is strongly associated with many important outcomes, including postoperative complications, length of stay, and mortality, little is known about the optimal management of postoperative patients with lactate elevations. This review ends with an assessment of the limited literature on this subject.

Association of intraoperative blood gas analysis with patient outcome after adult cardiac surgery

“…[30,31] Multiple non-pH blood gas parameters from different blood samples harvested at different stages of surgery also correlate with the outcomes measured in our study. Our findings are corroborated by the previous evidence showing that, in adult cardiac surgery, a higher arterial blood lactate concentration, [17,18] a greater central venous to arterial blood PCO 2 difference, [16] a higher [14] or lower[32] central venous blood oxygen saturation, and a lower mixed venous blood oxygen saturation [15] all correlate with unfavorable outcomes. It is also intriguing to ask, although it cannot be determined by our study, what the optimal bands within the normal ranges are of these parameters associated with more favorable outcomes.…”

“…Most blood gas parameters include pH, oxygen tension (PO 2 ), oxygen saturation (SO 2 ), carbon dioxide tension (PCO 2 ), and even lactate, can be modified during surgery. The associations of different blood gas parameters , such as central venous blood oxygen saturation, [14] mixed venous blood oxygen saturation, [15] central venous to arterial blood PCO 2 difference, [16] and lactate [17,18] with patient outcomes after cardiac surgery have been shown. Compared with the pHstat, the alpha-stat blood gas management leads to improve neuropsychologic outcomes in adult patients undergoing moderate hypothermic CPB.…”

Relationship Between Lactate Levels And Complications In Coronary Artery Bypass Grafting Surgery

“…Geniş hasta grupları ile yapılan çalışmalarda, hiperlaktatemi ile ilişkili en sık nedenin KPB süresi olduğu gösterilmiş-tir [1,5,6,13] . Bunun yanı sıra acil olgu olması, revizyon cerrahisi, düşük hemoglobin, renal yetmezlik olması, ejeksiyon fraksiyonu (EF) düşüklüğü ve diabetes mellitus nedenler arasında bulunmaktadır [10][11][12] .Yaş ile ilişkili olduğunu belirten çalışmalar olduğu gibi olmadığını söyleyen araştırmalar da mevcuttur [5,11] .…”

“…Kardiyopulmoner baypas (KPB) sırasında ortaya çıkan hemodilüs-yon ve düşük periferik oksijen sunumu doku hipoksisine neden olmaktadır. Oksijen sunumu kritik bir değerin altına düştüğünde oksijen tüketimi sunuma bağımlı hâle gelmekte ve laktik asidoz oluşmaktadır [5,6] . Kardiyopulmoner baypas sırasında inflamatuar yanıt olarak salınan bazı sitokinler ve diyabetojenik hormonlar laktat yüksekliğine, insülin rezistansına ve kan şekerinde artışa neden olmaktadır [7][8][9] .…”

“…Ek olarak yüksek doz β2 agonist ajan kullanımının da laktat seviyelerinde artışa neden olduğu bildirilmektedir. Bu nedenlede KPB sonrası komplikasyonlar ile ilişkili artmış laktat seviyelerini önlemek ve risk faktörlerini tanımlamak çok önemlidir [5,6] .…”