What is the clinical evidence from this study?

Study design: Observational. Population: Adult patients undergoing elective cardiac surgery under cardiopulmonary bypass (n=370). Intervention: Hyperlactatemia (serum lactate ≥4 mmol/L) vs. Serum lactate <4 mmol/L. Primary outcome: Prolonged requirement of inotropes (OR 5.66, 95% CI 3.06-10.48, p=0.001).

October 1, 2016Annals of Cardiac AnaesthesiaOpen Access

Hyperlactatemia in patients undergoing adult cardiac surgery under cardiopulmonary bypass: Causative factors and its effect on surgical outcome

Q: What are the key findings of this study?

Hyperlactatemia (≥4 mmol/L) during adult cardiac surgery under cardiopulmonary bypass was associated with a significantly higher risk of prolonged inotropic support (OR 5.66).

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Key result

Hyperlactatemia (≥4 mmol/L) during adult cardiac surgery under cardiopulmonary bypass was associated with a significantly higher risk of prolonged inotropic support (OR 5.66).

Why the study?

Does intraoperative hyperlactatemia (≥4 mmol/L) increase postoperative morbidity and mortality in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass?

Population

370 adult patients undergoing elective cardiac surgery under cardiopulmonary bypass with ejection fraction…

Comparison

Intraoperative peak blood lactate levels ≥ 4.0… vs Intraoperative peak blood lactate levels < 4.0…

Design

Cohort

Follow-up

In-hospital

Authors

RNRakesh Naik GGGladdy George SKSathappan Karuppiah

Discussion

Member takes

Overview

May prompt closer monitoring of inotropic needs; hypothesis-generating and requires prospective validation.

Study Design

Type

Observational (n=370)

Multicenter

Structured PICO

Does intraoperative hyperlactatemia (≥4 mmol/L) increase postoperative morbidity and mortality in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass?

Population

370 adult patients aged 18-75 years with an ejection fraction ≥40% undergoing elective cardiac surgery under cardiopulmonary bypass, evaluated for the effects of perioperative hyperlactatemia.

Exposure

Intraoperative peak blood lactate levels ≥ 4.0 mmol/L (Hyperlactatemia)

Comparator

Intraoperative peak blood lactate levels < 4.0 mmol/L

Outcome

Postoperative morbidity (atrial fibrillation, low cardiac output syndrome, central nervous system complications, respiratory complications, gastrointestinal complications, renal dysfunction, infection, length of stay in ICU and hospital) and in-hospital mortalityhard clinical

Main Result

Odds Ratio: 5.66 (95% CI 3.06–10.48)

Absolute Event Rate: 34% vs 11.8%

p-value: p=0.001

Intraoperative hyperlactatemia (≥4 mmol/L) during cardiopulmonary bypass is a significant predictor of postoperative morbidity, including atrial fibrillation and prolonged inotrope requirement, highlighting the need for aggressive correction of inadequate tissue oxygen delivery.

Limitations

Assessment of the impact of hyperlactatemia on postoperative mechanical ventilation days was flawed due to a routine overnight ventilation protocol.
Could not correlate hyperlactatemia with blood sugar levels due to strict glycemic control using an insulin sliding scale.
Small number of complex surgeries to derive statistical association between complexity of surgery and hyperlactatemia
Assessment of the impact of hyperlactatemia on postoperative mechanical ventilation days was flawed due to routine ICU protocol of not extubating patients during the night
Could not correlate hyperlactatemia with blood sugar levels due to strict glycemic control using an insulin sliding scale

Cite This Study

Naik et al. (2016) conducted an observational in Adult patients undergoing elective cardiac surgery under cardiopulmonary bypass (n=370). Hyperlactatemia (serum lactate ≥4 mmol/L) vs. Serum lactate <4 mmol/L was evaluated on Prolonged requirement of inotropes (OR 5.66, 95% CI 3.06-10.48, p=0.001). Hyperlactatemia (≥4 mmol/L) during adult cardiac surgery under cardiopulmonary bypass was associated with a significantly higher risk of prolonged inotropic support (OR 5.66).

synapsesocial.com/papers/6a75b91c50ae15bd7fd37986 https://doi.org/10.4103/0971-9784.191579

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October 1, 2016Annals of Cardiac AnaesthesiaOpen Access

Hyperlactatemia in patients undergoing adult cardiac surgery under cardiopulmonary bypass: Causative factors and its effect on surgical outcome

View Full Paper

Ask AI

Bookmark

Key result

Hyperlactatemia (≥4 mmol/L) during adult cardiac surgery under cardiopulmonary bypass was associated with a significantly higher risk of prolonged inotropic support (OR 5.66).

Why the study?

Does intraoperative hyperlactatemia (≥4 mmol/L) increase postoperative morbidity and mortality in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass?

Population

370 adult patients undergoing elective cardiac surgery under cardiopulmonary bypass with ejection fraction…

Comparison

Intraoperative peak blood lactate levels ≥ 4.0… vs Intraoperative peak blood lactate levels < 4.0…

Design

Cohort

Follow-up

In-hospital

Authors

RNRakesh Naik GGGladdy George SKSathappan Karuppiah

Discussion

Member takes

Overview

May prompt closer monitoring of inotropic needs; hypothesis-generating and requires prospective validation.

Study Design

Type

Observational (n=370)

Multicenter

Structured PICO

Does intraoperative hyperlactatemia (≥4 mmol/L) increase postoperative morbidity and mortality in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass?

Population

370 adult patients aged 18-75 years with an ejection fraction ≥40% undergoing elective cardiac surgery under cardiopulmonary bypass, evaluated for the effects of perioperative hyperlactatemia.

Exposure

Intraoperative peak blood lactate levels ≥ 4.0 mmol/L (Hyperlactatemia)

Comparator

Intraoperative peak blood lactate levels < 4.0 mmol/L

Outcome

Main Result

Odds Ratio: 5.66 (95% CI 3.06–10.48)

Absolute Event Rate: 34% vs 11.8%

p-value: p=0.001

Limitations

Assessment of the impact of hyperlactatemia on postoperative mechanical ventilation days was flawed due to a routine overnight ventilation protocol.
Could not correlate hyperlactatemia with blood sugar levels due to strict glycemic control using an insulin sliding scale.
Small number of complex surgeries to derive statistical association between complexity of surgery and hyperlactatemia
Assessment of the impact of hyperlactatemia on postoperative mechanical ventilation days was flawed due to routine ICU protocol of not extubating patients during the night
Could not correlate hyperlactatemia with blood sugar levels due to strict glycemic control using an insulin sliding scale

Cite This Study

synapsesocial.com/papers/6a75b91c50ae15bd7fd37986 https://doi.org/10.4103/0971-9784.191579

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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