Key result
Postoperative blood pressure fails to predict lactate clearance after cardiac surgery, whereas inotropes delay it.
Why the study?
It was unknown whether lower blood pressures, significant changes from baseline, and cardiac perfusion pressures delay the clearance of lactate after cardiac surgery.
Do lower postoperative blood pressures or significant changes from baseline delay lactate clearance in patients after cardiac surgery?
Cohort (n=81)
No
Do lower postoperative blood pressures or significant changes from baseline delay lactate clearance in patients after cardiac surgery?
Postoperative lactate clearance in cardiac surgery patients is largely independent of blood pressure in the first 16 hours but is significantly delayed in those requiring inotropic support.
Postop BP may not affect lactate clearance after cardiac surgery; leaves open whether inotropic support impairs clearance or indicates severity.
Background: Tight blood pressure control is a cornerstone of postoperative cardiac surgery patients. In addition, plasma lactate levels are frequently monitored in this setting as it is a marker for malperfusion, with early elevated levels being associated with increased morbidity and mortality. Elevations from malperfusion may be due to decreased cardiac output, hypovolemia, or persistent post-bypass vasoplegic response. Here, we investigate whether lower blood pressures, significant changes from baseline, and cardiac perfusion pressures delay the clearance of lactate after cardiac surgery. Methods: This is a retrospective cohort observational study of patients who have undergone coronary artery bypass graft (CABG) and valve replacement or repair surgeries at NYU Langone Long Island Hospital over a 6-month period. Postoperative blood pressures and lactate levels were examined over the first 16 h of care. Primary outcome: The relationship between blood pressure parameters and lactate clearance. Secondary outcomes: ICU length of stay, hospital length of stay, and mortality. Results: A total of 81 patients met inclusion criteria. The average pre-operative mean arterial blood pressure (MAP) was 95.4 mmHg and the average MAP in the first 6 h post-operatively was 78.4 mmHg. The average change in MAP from baseline was a decrease of 16.7%. The average cleared lactate fraction by 16 h postoperatively was 85.9%. Lactate clearance was associated in a statistically significant way only with the need for inotropic support on postoperative day 1, p = 0.03. There was a slight trend toward a delay in lactate clearance in those with lower early systolic blood pressures, p = 0.14. Conclusions: Lactate clearance appears to occur largely independently of postoperative blood pressures in the first 16 h after surgery but may be delayed in those requiring inotropic support through the morning or postoperative day one.
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Hall et al. (2025) conducted a cohort in Cardiac surgery (CABG and valve replacement or repair) (n=81). Postoperative blood pressure parameters was evaluated on Relationship between blood pressure parameters and lactate clearance (p=0.14). Postoperative blood pressures did not significantly affect lactate clearance after cardiac surgery (p=0.14), whereas clearance was delayed in patients requiring inotropic support (p=0.03).
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