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

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.

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

BMC Anesthesiology ◽

10.1186/s12871-021-01537-w ◽

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.

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

University Heart Journal ◽

10.3329/uhj.v13i2.37659 ◽

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

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

Bangladesh Heart Journal ◽

10.3329/bhj.v34i1.41904 ◽

2019 ◽

Vol 34 (1) ◽

pp. 25-30 ◽

Cited By ~ 1

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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