scholarly journals Target blood pressure management during cardiopulmonary bypass improves lactate levels after cardiac surgery: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qing Miao ◽  
Dong Jin Wu ◽  
Xu Chen ◽  
Meiying Xu ◽  
Lin Sun ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Blood Lactate ◽  
Lactate Level ◽  
Operation Time ◽  
Blood Lactate Level ◽  
Pressure Management ◽  
Lactate Levels ◽  
Group Target ◽  
Blood Lactate Levels

Abstract Background Hyperlactatemia is associated with a poor prognosis in cardiac surgery patients. This study explored the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate levels after cardiac surgery. Methods Adult patients undergoing cardiac valve surgery between 20/1/2020 and 30/6/2020 at Shanghai Chest Hospital were enrolled. The patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50 and 60 mmHg) or a high mean arterial pressure (H-MAP) group (target MAP between 70 and 80 mmHg), n = 20 for each. Norepinephrine was titrated only during CPB to maintain MAP at the target level. Blood lactate levels in the two groups were detected before the operation (T0), at the end of CPB (T1), at the end of the operation (T2), 1 h after the operation (T3), 6 h after the operation (T4) and 24 h after the operation (T5). The primary outcome was the blood lactate level at the end of the operation (T2). The secondary outcomes included the blood lactate level at T1, T3, T4, and T5 and the dose of epinephrine and dopamine within 24 h after the operation, time to extubation, length of stay in the ICU, incidence of readmission within 30 days, and mortality within 1 year. Results Forty patents were enrolled and analyzed in the study. The lactate level in the H-MAP group was significantly lower than that in the L-MAP group at the end of the operation (3.1 [IQR 2.1, 5.0] vs. 2.1 [IQR 1.7, 2.9], P = 0.008) and at the end of CPB and 1 hour after surgery. The dose of epinephrine within 24 h after the operation, time to extubation and length of stay in the ICU in the L-MAP group were significantly higher than those in the H-MAP group. Conclusions Maintaining a relatively higher MAP during CPB deceased the blood lactate level at the end of surgery, reduced epinephrine consumption, and shortened the time to extubation and length of stay in the ICU after surgery. Trial registration This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 8/1/2020 with the registration number ChiCTR2000028941. It was conducted from 20/1/2020 to 30/6/2020 as a single, blinded trial in Shanghai Chest Hospital.

scholarly journals Target blood pressure management during cardiopulmonary bypass improves lactate level after cardiac surgery: A randomized controlled trial

2021 ◽  
Author(s):  
Qing Miao ◽  
DongJin Wu ◽  
Xu Chen ◽  
Meiying Xu ◽  
Lin Sun ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Mean Arterial Pressure ◽  
Blood Lactate ◽  
Lactate Level ◽  
Blood Lactate Level ◽  
Pressure Management ◽  
Icu Stay ◽  
Group Target

Abstract Background：Hyperlactacidemia seriously affects the prognosis of cardiac surgery patients. This study was to explore the impact of target blood pressure management during cardiopulmonary bypass (CPB) on blood lactate level after cardiac surgery. Methods: Enrolled in this study were patients≧ 18 years who were scheduled for cardiac valve surgery between January 1, 2020 and June 30, 2020 at Shanghai Chest Hospital. The enrolled patients were randomized into a low mean arterial pressure (L-MAP) group (target MAP between 50-60mmHg) and a high mean arterial pressure (H-MAP) group (target MAP between 70-80 mmHg). Norepinephrine was titrated during CPB to maintain MAP at the target level.Blood lactate levels in the two groups were detect before operation (T0), at the end of CPB (T1), at the end of operation (T2), 1 h after operation (T3), 6 h after operation (T4) and 24 h after operation (T5) as the primary outcome. The secondary outcome was the dose of epinephrine and dopamine within 24 h after operation, at the time of extubation, during ICU stay, at the time of readmission within 30 days, and mortality in 1 year. Results: There was no significant difference in blood lactate level between the two groups at T0, T4 and T5. The lactate level in H-MAP group was significantly lower than that in L-MAP group (1.68±0.73, 2.33±0.93 and 2.90±1.09 mM;L-1 vs. 2.29±1.12, 3.63±1.86 and 4.60±2.24 mM;L-1) at T1, T2 and T3. The dose of epinephrine within 24 h after operation, at the time of extubation and during ICU stay in L-MAP group was significantly higher than that in H-MAP group. Conclusions: Target MAP management in patients with relatively high levels of MAP during CPB could decrease the blood lactate level, reduce epinephrine consumption, and shorten the time of extubation and length of ICU stay after surgery, thus improving the prognosis of cardiac surgery patients. Trial registration: This single-center single-blind RCT has completed the registration of the Chinese Clinical Trial Center with the registration number ChiCTR2000028941.

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

Perfusion ◽  
2019 ◽  
Vol 34 (8) ◽  
pp. 640-650 ◽  
Author(s):  
Benoit Duval ◽  
Thibaud Besnard ◽  
Stefano Mion ◽  
Sébastien Leuillet ◽  
Olivier Jecker ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Blood Lactate ◽  
Lactate Level ◽  
Blood Lactate Level ◽  
Short Term ◽  
Laboratory Test Results ◽  
Lactate Levels ◽  
Blood Lactate Levels

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.

scholarly journals Alteration of Blood Lactate Levels in Severe Falciparum Malaria: A Systematic Review and Meta-Analysis

Biology ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1085
Author(s):  
Polrat Wilairatana ◽  
Wanida Mala ◽  
Manas Kotepui ◽  
Kwuntida Uthaisar Kotepui
Keyword(s):  
Severe Malaria ◽  
Blood Lactate ◽  
Lactate Level ◽  
Uncomplicated Malaria ◽  
Weighted Mean Difference ◽  
Blood Lactate Level ◽  
Mean Difference ◽  
The Mean ◽  
Lactate Levels ◽  
Blood Lactate Levels

Metabolic acidosis in severe malaria usually occurs in the form of lactic acidosis. The present study aimed to collate articles from the literature that have reported blood lactate levels in patients with severe malaria and tested the hypothesis that blood lactate levels are elevated in patients with malaria compared to those with uncomplicated malaria. Moreover, the difference in lactate levels between patients who died and those who survived was estimated using a meta-analytic approach. Potentially relevant studies were searched for in PubMed, Web of Science, and Scopus. The quality of the included studies was assessed using the Jadad scale and strengthening the reporting of observational studies in epidemiology (STROBE). The pooled mean blood lactate in patients with severe malaria, the pooled weighted mean difference (WMD) of blood lactate between patients with severe malaria and those with uncomplicated malaria, and the pooled WMD and 95% CI of blood lactate between patients who died from and those who survived severe malaria were estimated using the random-effects model. Heterogeneity among the outcomes of the included studies was assessed using Cochran’s Q and I2 statistics. A meta-regression analysis was performed to identify the source(s) of heterogeneity of outcomes among the included studies. A subgroup analysis was further performed to separately analyze the outcomes stratified by the probable source(s) of heterogeneity. Publication bias was assessed by the visual inspection of the funnel plot asymmetry. Of 793 studies retrieved from the searches, 30 studies were included in qualitative and quantitative syntheses. The pooled mean lactate in patients with severe malaria was 5.04 mM (95% CI: 4.44–5.64; I2: 99.9%; n = 30,202 cases from 30 studies). The mean lactate in patients with severe malaria (1568 cases) was higher than in those with uncomplicated malaria (1693 cases) (p = 0.003; MD: 2.46; 95% CI: 0.85–4.07; I2: 100%; nine studies). The mean lactate in patients with severe malaria who died (272 cases) was higher than in those with severe malaria who survived (1370 cases) (p < 0.001; MD: 2.74; 95% CI: 1.74–3.75; I2: 95.8%; six studies). In conclusion, the present study showed a high mean difference in blood lactate level between patients with severe malaria and patients with uncomplicated malaria. In addition, there was a high mean difference in blood lactate level between patients with severe malaria who died compared to those with severe malaria who survived. Further studies are needed to investigate the prognostic value of blood lactate levels to identify patients who are at high risk of developing severe malaria or dying.

scholarly journals Prehospital lactate improves prediction of the need for immediate interventions for hemorrhage after trauma

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Hiroshi Fukuma ◽  
Taka-aki Nakada ◽  
Tadanaga Shimada ◽  
Takashi Shimazui ◽  
Tuerxun Aizimu ◽  
...  
Keyword(s):  
Blood Lactate ◽  
Lactate Level ◽  
Area Under The Curve ◽  
Blood Lactate Level ◽  
Trauma Patients ◽  
Circulatory Disturbance ◽  
Physiological Variables ◽  
Level I ◽  
Lactate Levels ◽  
Blood Lactate Levels

Abstract The blood lactate level is used to guide the management of trauma patients with circulatory disturbance. We hypothesized that blood lactate levels at the scene (Lac scene) could improve the prediction for immediate interventions for hemorrhage. We prospectively measured blood lactate levels and assessed retrospectively in 435 trauma patients both at the scene and on arrival at the emergency room (ER) of a level I trauma center. Primary outcome was immediate intervention for hemorrhage defined as surgical/radiological intervention and/or blood transfusion within 24 h. Physiological variables plus Lac scene significantly increased the predictive value for immediate intervention (area under the curve [AUC] 0.882, 95% confidence interval [CI] 0.839–0.925) compared to that using physiological variables only (AUC 0.837, 95% CI 0.787–0.887, P = 0.0073), replicated in the validation cohort (n = 85). There was no significant improvement in predicting value of physiological variables plus Lac scene for massive transfusion compared to physiological variables (AUC 0.903 vs 0.895, P = 0.32). The increased blood lactate level per minute from scene to ER was associated with increased probability for immediate intervention (P < 0.0001). Both adding Lac scene to physiological variables and the temporal elevation of blood lactate levels from scene to ER could improve the prediction of the immediate intervention.

scholarly journals Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study

2020 ◽  
Vol 9 (10) ◽  
pp. 3290
Author(s):  
Romain Jouffroy ◽  
Teddy Léguillier ◽  
Basile Gilbert ◽  
Jean Pierre Tourtier ◽  
Emmanuel Bloch-Laine ◽  
...  
Keyword(s):  
Septic Shock ◽  
Blood Lactate ◽  
Disease Severity ◽  
Lactate Level ◽  
Cox Regression ◽  
Blood Lactate Level ◽  
Controlled Study ◽  
Cox Regression Analysis ◽  
Lactate Levels ◽  
Blood Lactate Levels

Background: Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. In both pre- and in-hospital settings, the clinical picture alone is not sufficient for assessing disease severity and outcomes. Because blood lactate level is included in the clinical criteria of SS it should be considered to improve the assessment of its severity. This study aims to investigate the relationship between pre-hospital blood lactate level and 30-day mortality in patients with SS. Methods: From 15 April 2017 to 15 April 2019, patients with SS requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were prospectively included in the LAPHSUS study, an observational, non-randomized controlled study. Pre-hospital blood lactate levels were measured at the time of first contact between the patients and the MICU. Results: Among the 183 patients with septic shock requiring action by the MICU drawn at random from LAPHSUS study patients, six (3%) were lost to follow-up on the 30th day and thus 177 (97%) were analyzed for blood lactate levels (mean age 70 ± 14 years). Pulmonary, urinary and digestive infections were probably the cause of the SS in respectively 58%, 21% and 11% of the cases. The 30-day overall mortality was 32%. Mean pre-hospital lactatemia was significantly different between patients who died and those who survived (respectively 7.1 ± 4.0 mmol/L vs. 5.9 ± 3.5 mmol/L, p < 10−3). Using Cox regression analysis adjusted for potential confounders we showed that a pre-hospital blood lactate level ≥ 4 mmol/L significantly predicted 30-day mortality in patients with SS (adjusted hazard ratio = 2.37, 95%CI (1.01–5.57), p = 0.04). Conclusion: In this study, we showed that pre-hospital lactatemia predicts 30-day mortality in patients with septic shock handled by the MICU. Further studies will be needed to evaluate if pre-hospital lactatemia alone or combined with clinical scores could affect the triage decision-making process for those patients.

Multisite Near-Infrared Spectroscopy Predicts Elevated Blood Lactate Level in Children After Cardiac Surgery

2009 ◽  
Vol 23 (5) ◽  
pp. 663-667 ◽  
Author(s):  
Sujata B. Chakravarti ◽  
Alexander J.C. Mittnacht ◽  
Jason C. Katz ◽  
Khahn Nguyen ◽  
Umesh Joashi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Infrared Spectroscopy ◽  
Blood Lactate ◽  
Near Infrared Spectroscopy ◽  
Lactate Level ◽  
Near Infrared ◽  
Blood Lactate Level ◽  
Elevated Blood

scholarly journals Blood Lactate Level as Predictor of Early Outcome after Cardiac Surgery under Cardiopulmonary Bypass

2018 ◽  
Vol 13 (2) ◽  
pp. 50-54
Author(s):  
Md Abul Kalam Azad ◽  
Md Abul Quashem ◽  
Md Rezaul Karim ◽  
Md Kamrul Hasan
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Lactate ◽  
Lactate Level ◽  
Prolonged Mechanical Ventilation ◽  
Blood Lactate Level ◽  
Binary Logistic Regression Analysis ◽  
Early Outcome ◽  
Icu Transfer ◽  
Adult Cardiac Surgery

We examined the hypothesis that high blood lactate level in ICU patient after adult cardiac surgery under cardiopulmonary bypass is associated with early adverse outcome. The objective of this study was to evaluate whether blood lactate level after cardiac surgery is predictor of the early outcome after adult cardiac surgery under CPB. In this prospective observational study total 100 patients were enrolled who underwent elective cardiac surgery under CPB as per inclusion and exclusion criteria. Blood lactate levels > 3mmol/ L 6 hours after ICU transfer were present in 57(57%) patients. The binary logistic regression analysis showed that blood lactate level 6 hours after ICU transfer is an independent predictor for prolonged mechanical ventilation time (OR 2.417, 95% CI 1.272 - 4.596, p = .007), prolonged ICU stay (OR 1.562, 95% CI 1.181 - 2.067, p = .002), neurological deficit (OR 2.432, 95% CI 1.539 - 3.843, p = .001), pulmonary complication (OR 1.301, 95% CI 1.011 - 1.676, p = .041), arrhythmia (OR 1.444, 95% CI 1.102 - 1.893, p = .008), renal dysfunction (OR 1.838, 95% CI 1.352 - 2.497, p = .001) and mortality (OR 1.822, 95% CI 1.123- 2.955, p = .015). In conclusion, blood lactate level 6 hours after ICU transfer is an independent risk factor for worse outcomes in adult patients including mortality after cardiac surgery under CPB.University Heart Journal Vol. 13, No. 2, July 2017; 50-54

scholarly journals Evaluation of Blood Lactate Level as Predictor of Early Adverse Outcome after Cardiac Surgery under Cardiopulmonary Bypass

2019 ◽  
Vol 34 (1) ◽  
pp. 25-30 ◽  
Author(s):  
MAK Azad ◽  
KS Islam ◽  
MA Quasem
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Cardiopulmonary Bypass ◽  
Blood Lactate ◽  
Lactate Level ◽  
Adverse Outcome ◽  
Independent Predictor ◽  
Blood Lactate Level ◽  
Adult Cardiac Surgery

Background: We examined the hypothesis that high blood lactate level in intensive care unit patient after adult cardiac surgery under cardiopulmonary bypass is associated with early adverse outcome. The objective of this study was to evaluate whether high blood lactate level after cardiac surgery is a predictor of the early outcome after adult cardiac surgery under cardiopulmonary bypass. Methods: This prospective observational study was carried out in the department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka from July, 2013 to April 2014. A total number of 100 patients who underwent cardiac operation with cardiopulmonary bypass were enrolled in this study as per inclusion and exclusion criteria. Patients were divided into two groups according to their blood lactate level 6 hours after transferintensive care unit. Peroperative variables and postoperative variables were observed and recorded during the hospital course of patient. Categorical variables were analyzed by Chi- Square test and Fisher’s exact test and continuous variables were analyzed by ‘t’ test. Multiple Binary Logistic Regression Analysis of predictors for each of the outcome variables was done. Results: Blood lactate levels ≥3mmol/L 6 hours after transfer to intensive care unit were present in 57(57%) patients. Multiple logistic regression analysis showed higher blood lactate level was an independent predictor for early postoperative low output syndrome (OR 9.073, 95% CI 2.819 – 29.207, p = < .0001), pulmonary complication (OR 5.734, 95% CI 1.814 – 18.122, p = .003), neurological deficits (OR 9.725, 95% CI 1.111 - 85.147, p = .040), renal dysfunction (OR 7.393, 95% CI 1.855-29.469, p = .005), arrhythmia (OR 10.512, 95% CI 1.902 – 58.108, p = .007) and wound infection (OR 7.742, 95% CI 1.418 - 42.259, p = .018). Conclusions: High blood lactate level 6 hours after transfer to intensive care unit is an independent predictor for worse outcomes in adult patients after cardiac surgery under cardiopulmonary bypass. Bangladesh Heart Journal 2019; 34(1) : 25-30

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