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Critical Care
Published in: Critical Care 6/2006

Open Access 01-12-2006 | Research

Hyperlactatemia during cardiopulmonary bypass: determinants and impact on postoperative outcome

Authors: Marco Ranucci, Barbara De Toffol, Giuseppe Isgrò, Federica Romitti, Daniela Conti, Maira Vicentini

Published in: Critical Care | Issue 6/2006

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Abstract

Introduction

Hyperlactatemia during cardiopulmonary bypass is relatively frequent and is associated with an increased postoperative morbidity. The aim of this study was to determine which perfusion-related factors may be responsible for hyperlactatemia, with specific respect to hemodilution and oxygen delivery, and to verify the clinical impact of hyperlactatemia during cardiopulmonary bypass in terms of postoperative morbidity and mortality rate.

Methods

Five hundred consecutive patients undergoing cardiac surgery with cardiopulmonary bypass were admitted to this prospective observational study. During cardiopulmonary bypass, serial arterial blood gas analyses with blood lactate and glucose determinations were obtained. Hyperlactatemia was defined as a peak arterial blood lactate concentration exceeding 3 mmol/l. Pre- and intraoperative factors were tested for independent association with the peak arterial lactate concentration and hyperlactatemia. The postoperative outcome of patients with or without hyperlactatemia was compared.

Results

Factors independently associated with hyperlactatemia were the preoperative serum creatinine value, the presence of active endocarditis, the cardiopulmonary bypass duration, the lowest oxygen delivery during cardiopulmonary bypass, and the peak blood glucose level. Once corrected for other explanatory variables, hyperlactatemia during cardiopulmonary bypass remained significantly associated with an increased morbidity, related mainly to a postoperative low cardiac output syndrome, but not to mortality.

Conclusion

Hyperlactatemia during cardiopulmonary bypass appears to be related mainly to a condition of insufficient oxygen delivery (type A hyperlactatemia). During cardiopulmonary bypass, a careful coupling of pump flow and arterial oxygen content therefore seems mandatory to guarantee a sufficient oxygen supply to the peripheral tissues.
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Metadata
Title
Hyperlactatemia during cardiopulmonary bypass: determinants and impact on postoperative outcome
Authors
Marco Ranucci
Barbara De Toffol
Giuseppe Isgrò
Federica Romitti
Daniela Conti
Maira Vicentini
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2006
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc5113

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