Does severe hyperlactatemia during cardiopulmonary bypass predict a worse outcome?

Autor:	Seghrouchni A; Cardiovascular Surgery Department, Mohammed V Military Training Hospital, Rabat, Morocco.; Faculty of Medicine and Pharmacy, University of Sidi Mohamed Ben Abdellah, Fes, Morocco., Atmani N; Cardiovascular Surgery Department, Mohammed V Military Training Hospital, Rabat, Morocco.; Faculty of Medicine and Pharmacy, University of Sidi Mohamed Ben Abdellah, Fes, Morocco., Moutakiallah Y; Cardiovascular Surgery Department, Mohammed V Military Training Hospital, Rabat, Morocco., Belmekki A; Hematology Teaching and Research Unit, Faculty of Medicine and Pharmacy, Rabat, Morocco., El Bekkali Y; Cardiovascular Surgery Department, Mohammed V Military Training Hospital, Rabat, Morocco., Houssa MA; Cardiovascular Surgery Department, Mohammed V Military Training Hospital, Rabat, Morocco.
Jazyk:	angličtina
Zdroj:	Annals of medicine and surgery (2012) [Ann Med Surg (Lond)] 2021 Dec 21; Vol. 73, pp. 103198. Date of Electronic Publication: 2021 Dec 21 (Print Publication: 2022).
DOI:	10.1016/j.amsu.2021.103198
Abstrakt:	Introduction: The aim of the current study was to evaluate the impact of increased blood lactate levels during cardiopulmonary bypass (CPB) on immediate results in patients who underwent open heart surgery. Materials and Methods: We performed a retrospective single-center study on 1290 patients. Adult cardiac surgical patients who underwent valve surgery, coronary artery bypass graft, combined procedure, adult congenital anomalies and aortic surgery were enrolled. Patients with associated comorbidities such as liver dysfunction, hemodynamic instability before surgery were excluded. Arterial blood lactate concentration was measured immediately after weaning from CPB and evaluated together with clinical data and outcomes including in hospital mortality. Patients were classified into 3 groups according to their peak arterial lactate level: group I [normal lactatemia, lactate ˂ 2 mmol/l (n = 749)], group II [mild hyperlactatemia, lactate 2-5 mmol/l (n = 489)], group III [severe hyperlactatemia, lactate ˃ 5 mmol/l (n = 52)]. Results: When comparing outcomes across the 3 groups, severe hyperlactatemia was correlated with worse outcomes including higher in-hospital mortality, low output cardiac syndrome, postoperative renal insufficiency, myocardial infarction, red blood cell transfusion (RBC) transfusion, prolonged mechanical ventilation and longer intensive care unit (ICU) stay hours. Conclusion: Blood lactate level above 5 mmol/l and more during CPB is associated with higher in-hospital mortality rate and postoperative complications. More attention must be given to correct the common abnormalities conditions inherent of CPB in order to conduct adequate tissue perfusion and reduce the risk of hyperlactatemia. Competing Interests: The authors report no conflicts of interest (© 2021 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.)
Databáze:	MEDLINE
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