What question did this study set out to answer?

To evaluate the relationship between intraoperative changes in blood lactate levels (∆Lact) and postoperative intensive care unit morbidity and 30-day all-cause mortality in patients undergoing cardiac surgery with cardiopulmonary bypass.

June 28, 2019PerfusionOpen Access

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

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Why the study?

High perioperative blood lactate is associated with poor outcomes after cardiac surgery, but evaluating changes in intraoperative blood lactate rather than isolated peaks may be more informative.

Is an intraoperative increase in blood lactate level associated with worse short-term outcomes in patients undergoing on-pump cardiac surgery?

Population

7,447 consecutive patients undergoing on-pump cardiac surgery

Comparison

Intraoperative lactate change stratified into ⩽0, 0.1-0.9, 1-1.9, and ⩾2 mmol L-1

Design

Retrospective single-institution database study

Follow-up

30 days

Authors

BDBenoît Duval TBThibaud Besnard SMStéfano Mion

Discussion

Member takes

Overview

May warrant closer monitoring for rising intraoperative lactate; hypothesis-generating pending prospective trials.

Key Points

To evaluate the relationship between intraoperative changes in blood lactate levels (∆Lact) and postoperative intensive care unit morbidity and 30-day all-cause mortality in patients undergoing cardiac surgery with cardiopulmonary bypass.
Retrospectively analyzed prospectively collected data from consecutive adult patients undergoing on-pump cardiac surgery between September 2010 and June 2016 (N=7,447 analyzed of 7,795 eligible).
Calculated ∆Lact as the difference between peak intraoperative and baseline lactate (measured post-anesthesia induction), stratifying patients into four subgroups: ≤0, 0.1–0.9, 1–1.9, and ≥2 mmol L⁻¹.
The median ∆Lact was 0.6 mmol L⁻¹ (interquartile range, 0.3–1.0 mmol L⁻¹), with 65.9% of the cohort exhibiting a ∆Lact between 0.1 and 0.9 mmol L⁻¹.
A concentration-dependent relationship was observed where any ∆Lact > 0 mmol L⁻¹ independently associated with increased overall intensive care unit morbidity after multivariable adjustment.
An independent relationship with increased 30-day all-cause mortality emerged starting at a ∆Lact increase of ≥1.0 mmol L⁻¹.

Structured PICO

Is an intraoperative increase in blood lactate level associated with worse short-term outcomes in patients undergoing on-pump cardiac surgery?

Population

7,447 adult patients undergoing on-pump cardiac surgery

Intervention

Intraoperative increase in blood lactate level (∆Lact > 0 mmol L-1)

Comparator

No increase or lower increases in intraoperative blood lactate level (∆Lact ⩽0 mmol L-1)

Outcome

Overall intensive care unit morbidity and 30-day all-cause mortalityhard clinical

Intraoperative increases in blood lactate levels during on-pump cardiac surgery are independently associated with increased ICU morbidity and 30-day mortality.

Cite This Study

Duval et al. (2019) studied this question.

synapsesocial.com/papers/6a72ecd44aaee9d3921cf48d https://doi.org/10.1177/0267659119855857

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June 28, 2019PerfusionOpen Access

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

View Full Paper

Ask AI

Bookmark

Why the study?

High perioperative blood lactate is associated with poor outcomes after cardiac surgery, but evaluating changes in intraoperative blood lactate rather than isolated peaks may be more informative.

Is an intraoperative increase in blood lactate level associated with worse short-term outcomes in patients undergoing on-pump cardiac surgery?

Population

7,447 consecutive patients undergoing on-pump cardiac surgery

Comparison

Intraoperative lactate change stratified into ⩽0, 0.1-0.9, 1-1.9, and ⩾2 mmol L-1

Design

Retrospective single-institution database study

Follow-up

30 days

Authors

BDBenoît Duval TBThibaud Besnard SMStéfano Mion

Discussion

Member takes

Overview

May warrant closer monitoring for rising intraoperative lactate; hypothesis-generating pending prospective trials.

Key Points

To evaluate the relationship between intraoperative changes in blood lactate levels (∆Lact) and postoperative intensive care unit morbidity and 30-day all-cause mortality in patients undergoing cardiac surgery with cardiopulmonary bypass.
Retrospectively analyzed prospectively collected data from consecutive adult patients undergoing on-pump cardiac surgery between September 2010 and June 2016 (N=7,447 analyzed of 7,795 eligible).
Calculated ∆Lact as the difference between peak intraoperative and baseline lactate (measured post-anesthesia induction), stratifying patients into four subgroups: ≤0, 0.1–0.9, 1–1.9, and ≥2 mmol L⁻¹.
The median ∆Lact was 0.6 mmol L⁻¹ (interquartile range, 0.3–1.0 mmol L⁻¹), with 65.9% of the cohort exhibiting a ∆Lact between 0.1 and 0.9 mmol L⁻¹.
A concentration-dependent relationship was observed where any ∆Lact > 0 mmol L⁻¹ independently associated with increased overall intensive care unit morbidity after multivariable adjustment.
An independent relationship with increased 30-day all-cause mortality emerged starting at a ∆Lact increase of ≥1.0 mmol L⁻¹.

Structured PICO

Is an intraoperative increase in blood lactate level associated with worse short-term outcomes in patients undergoing on-pump cardiac surgery?

Population

7,447 adult patients undergoing on-pump cardiac surgery

Intervention

Intraoperative increase in blood lactate level (∆Lact > 0 mmol L-1)

Comparator

No increase or lower increases in intraoperative blood lactate level (∆Lact ⩽0 mmol L-1)

Outcome

Overall intensive care unit morbidity and 30-day all-cause mortalityhard clinical

Intraoperative increases in blood lactate levels during on-pump cardiac surgery are independently associated with increased ICU morbidity and 30-day mortality.

Cite This Study

Duval et al. (2019) studied this question.

synapsesocial.com/papers/6a72ecd44aaee9d3921cf48d https://doi.org/10.1177/0267659119855857

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