Hyperlactatemia during cardiopulmonary bypass: determinants and impact on postoperative outcome

IntroductionHyperlactatemia 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.MethodsFive 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.ResultsFactors 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.ConclusionHyperlactatemia 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.

• Publication year

  2006

• Venue

  Critical Care

• Publication date

  2006-11-29

• Fields of study

  Medicine

• Identifiers
  DOI 10.1186/cc5113PMID 17134504PMCID 1794481
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Anaerobic metabolism during cardiopulmonary bypass: predictive value of carbon dioxide derived parameters.

  2006cited by this paper
• Beyond global oxygen supply-demand relations: In search of measures of dysoxia

  2006cited by this paper
• Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations.

  2005cited by this paper
• Lactate and glucose metabolism in severe sepsis and cardiogenic shock*

  2005cited by this paper
• Adverse effects of low hematocrit during cardiopulmonary bypass in the adult: should current practice be changed?

  2003cited by this paper
• The association of lowest hematocrit during cardiopulmonary bypass with acute renal injury after coronary artery bypass surgery.

  2003cited by this paper
• Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery.

  2003cited by this paper
• Metabolic Effects of Norepinephrine and Dobutamine in Healthy Volunteers

  2002cited by this paper
• Effects of body size on operative, intermediate, and long-term outcomes after coronary artery bypass operation.

  2001cited by this paper
• Outcome with high blood lactate levels during cardiopulmonary bypass in adult cardiac operation.

  2000cited by this paper
• Effects of cardiogenic shock on lactate and glucose metabolism after heart surgery

  2000cited by this paper
• Case 2-1999. Severe lactic acidosis after cardiac surgery: sign of perfusion deficits?

  1999cited by this paper
• Type B lactic acidosis following cardiopulmonary bypass.

  1997cited by this paper
• Epinephrine-induced lactic acidosis following cardiopulmonary bypass.

  1997cited by this paper
• Lactate metabolism and regional lactate exchange after cardiac surgery.

  1996cited by this paper
• Oxygen delivery in critically ill patients

  1996cited by this paper
• The relationship between oxygen delivery and uptake in the critically ill: is there a critical or optimal therapeutic value?

  1994cited by this paper
• Splanchnic lactate production in cardiac surgery patients

  1993cited by this paper
• Beyond the lung: oxygen delivery and tissue oxygenation

  1993cited by this paper
• Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock.

  1991cited by this paper
• Splanchnic glucose balance and insulin resistance in the early postoperative phase of cardiac surgery.

  1988cited by this paper
• Oxygen delivery in critically ill patients. Relationship to blood lactate and survival.

  1985cited by this paper
• Serial lactate determinations during circulatory shock

  1983cited by this paper
• Experimental and Clinical Studies on Lactate and Pyruvate as Indicators of the Severity of Acute Circulatory Failure (Shock)

  1970cited by this paper

• The lactate risk score (LRS): Anticipating hyperlactatemia during cardiopulmonary bypass.

  2026cites this paper
• Exploration of Acid-base Disorders in the Post-operative Post-cardiac Surgery Period

  2026cites this paper
• Indexed Delivery of Oxygen Predicts In-hospital Mortality and Morbidity in Reoperative Adult Cardiac Surgery Patients: A Retrospective Cohort Study.

  2026cites this paper
• Profile and Predictive Factors of Postoperative Lactic Acidosis in Pediatric Cardiac Surgery Under Extracorporeal Circulation

  2026cites this paper
• The Clinical Outcome of Elevated Peri-Operative Lactate Levels in Patients Undergoing Craniotomy

  2026cites this paper
• Association between intraoperative lactate levels and acute kidney injury after on-pump cardiac surgery: a retrospective cohort study across two centers

  2025influential citation
• Post-Operative Haemodynamic Monitoring of Patients undergoing Corrective Open Heart Surgery for Structural Heart Defects

  2025cites this paper
• The relationship of serum lactate level with in-hospital mortality after transcatheter aortic valve implantation.

  2025cites this paper
• A Temperature-Adjusted Algorithm for Predicting Critical Indexed Oxygen Delivery (DO₂i) During Cardiopulmonary Bypass

  2025cites this paper
• Effect of Mannitol on Renal Function during Cardiac Surgery and Immediate Post-Operative in Selected Private Hospitals in Nablus City/ Palestine

  2025cites this paper
• Short- and Medium-Term Surgical Outcomes of Tissue-Engineered Pulmonary Valve Replacement in Sheep

  2025cites this paper
• To Assess the Impact of Glucose, Insulin, and Potassium Chloride Infusions in Patients after Cardiothoracic Surgery on Arrhythmias and Outcome

  2025cites this paper
• Implementation of a goal directed perfusion strategy to reduce cardiac surgery associated kidney injury: A before and after study.

  2025cites this paper
• Oxygen Delivery During Cardiopulmonary Bypass in Pediatric Patients With Congenital Heart Disease: Association With Postoperative Acute Kidney Injury.

  2024cites this paper
• Conservative fluid resuscitation protocol does not reduce the incidence of reoperation for bleeding after emergency CABG

  2024cites this paper
• Anaerobic Lactate Production Is Associated With Decreased Microcirculatory Blood Flow and Decreased Mitochondrial Respiration Following Cardiovascular Surgery With Cardiopulmonary Bypass*

  2024cites this paper
• Mean Arterial Pressure (MAP) Trial: study protocol for a multicentre, randomized, controlled trial to compare three different strategies of mean arterial pressure management during cardiopulmonary bypass

  2024cites this paper
• Relationship between lactate-to-albumin ratio and 28-day mortality in patients with exacerbation of chronic obstructive pulmonary disease admitted to the Intensive Care Unit

  2024cites this paper
• Comparison GDP and conventional CPB impact on metabolism in cardiac center Sardjito general hospital

  2024cites this paper
• The Impact of Intraoperative Hyperlactatemia on Weaning from Cardiopulmonary Bypass in Patients Undergoing on-Pump Coronary Artery Bypass Grafting Surgery: An Observational Study

  2024cites this paper
• Incidence and risk factors of acute kidney injury in redo cardiac surgery: a single center analysis

  2024cites this paper
• Association between lactic acidosis and multiple organ dysfunction syndrome after cardiopulmonary bypass

  2024cites this paper
• Changes in various forms of fibronectin in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass – a prospective, observational study

  2024cites this paper
• Hyperlactatemia in patients undergoing pulmonary endarterectomy with deep hypothermic circulatory arrest: Risk factors and its effects on the outcome.

  2023cites this paper
• Intraoperative use of cell saver devices decreases the rate of hyperlactatemia in patients undergoing cardiac surgery

  2023cites this paper
• Relationship between the postoperative lactate dynamic levels, the acute gastrointestinal injury and the prognosis among patients who undergo surgical treatment for acute type A aortic dissection

  2023cites this paper
• Can Hyperlactatemia be an Early Indicator of Adverse Outcomes Post Coronary Artery Bypass Surgery in Subjects with Thyroid Disorder?

  2023cites this paper
• Anesthesia Considerations in Infective Endocarditis

  2022cites this paper
• Ácido láctico y asociación con la mortalidad en el posoperatorio de cirugía cardiaca. Estudio cohorte retrospectiva

  2022cites this paper
• Effects of norepinephrine infusion during cardiopulmonary bypass on perioperative changes in lactic acid level (Norcal)

  2022cites this paper
• The new frontiers of Extracorporeal Perfusion

  2022cites this paper
• Non-invasive and invasive measurement of skeletal muscular oxygenation during isolated limb perfusion

  2022cites this paper
• Non-invasive and invasive measurement of skeletal muscular oxygenation during isolated limb perfusion.

  2022cites this paper
• Preoperative ultrasound-guided bilateral thoracic erector spinae plane block within an enhanced recovery program is associated with decreased intraoperative lactate levels in cardiac surgery

  2022cites this paper
• Intraoperative Oxygen Practices in Cardiac Surgery: A National Survey.

  2022cites this paper
• Prognostic role of perioperative acid-base disturbances on the risk of Clostridioides difficile infection in patients undergoing cardiac surgery

  2021influential citation
• Prognostic Value of the Leuko-Glycaemic Index in the Postoperative Period of Coronary Artery Bypass Grafting

  2021cites this paper
• Target blood pressure management during cardiopulmonary bypass improves lactate levels after cardiac surgery: a randomized controlled trial

  2021cites this paper
• ‘Goal-directed extracorporeal circulation: transferring the knowledge and experience from daily cardiac surgery to extracorporeal membrane oxygenation’

  2021cites this paper
• Performance of Sequential Organ Failure Assessment and Simplified Acute Physiology Score II for Post-Cardiac Surgery Patients in Intensive Care Unit

  2021cites this paper
• Impact of Single versus Double Clamp Technique on Blood Lactate Levels and Postoperative Complications in Coronary Artery Bypass Surgery

  2021influential citation
• Minimal Invasive Extra-corporeal Circulation on End Stage Coronary Artery Disease Patients Undergoing Myocardial Revascularization

  2021cites this paper
• Machine Learning Prediction Models for Mortality in Intensive Care Unit Patients with Lactic Acidosis

  2021cites this paper
• Does severe hyperlactatemia during cardiopulmonary bypass predict a worse outcome?

  2021cites this paper
• Monitoring of the Progression of the Perioperative Serum Lactate Concentration Improves the Accuracy of the Prediction of Acute Mesenteric Ischemia Development After Cardiovascular Surgery.

  2021cites this paper
• Results and risk factors of high lactate level after open-heart surgery

  2021cites this paper
• The Outcomes of Tracheostomy in Pediatric Cardiac Surgical Patients

  2021cites this paper
• Machine Learning Consensus Clustering Approach for Patients with Lactic Acidosis in Intensive Care Units

  2021cites this paper
• What are the non-cardiac prognostic factors affecting mortality in neonates with aortopulmonary shunt

  2021cites this paper
• Minimally invasive extracorporeal circulation in end-stage coronary artery disease patients undergoing myocardial revascularization

  2021cites this paper
• Resistance Index of the Superior Mesenteric Artery: Correlation With Lactate Concentration and Kinetics Prediction After Cardiac Surgery

  2021cites this paper
• Arterial lactate levels and their prognostic value in patients undergoing pulmonary thromboendarterectomy

  2021cites this paper
• Development and validation of a nomogram model for early postoperative hyperlactatemia in patients undergoing cardiac surgery

  2021cites this paper
• Hyperlactatemia and its adverse patient outcomes among patients who underwent cardiopulmonary bypass surgery at national cardiac centre Addis Ababa, Ethiopia 2021. Retrospective observational study

  2021cites this paper
• The effect of hyperlactatemia timing on the outcomes after cardiac surgery

  2020cites this paper
• Modified Glucose‐Insulin‐Potassium Regimen Provides Cardioprotection With Improved Tissue Perfusion in Patients Undergoing Cardiopulmonary Bypass Surgery

  2020influential citation
• Critical indexed oxygen delivery as a cornerstone of goal-directed perfusion in neonates undergoing cardiac surgery. Comment on Br J Anaesth 2020; 124: 395-402.

  2020cites this paper
• Serum Lactate-A Prognostic Marker of Early Post-Operative Outcome After Off Pump Coronary Artery Bypass Surgery: A Propensity Matched Study

  2020cites this paper
• Efficacy of Glyceryl trinitrate (GTN) to facilitate the rewarming process during cardiopulmonary bypass

  2020cites this paper
• Commentary: Hyperlactatemia after cardiac surgery: Yes we know it is bad but can we reliably prevent and treat it?

  2020cites this paper
• Markers of Poor Prognosis in Patients Requiring Continuous Renal Replacement Therapy After Cardiac Surgery.

  2020cites this paper
• Relación de p v-aCO2/Da-vO2 con marcadores de hipoperfusión tisular y desenlace clínico, en pacientes en posoperatorio de cirugía cardiaca

  2020cites this paper
• A retrospective analysis of CO2 derived goal-directed perfusion variables under normothermic conditions: do we need to re-evaluate threshold values?

  2020cites this paper
• Severe Impairment of Microcirculatory Perfused Vessel Density Is Associated With Postoperative Lactate and Acute Organ Injury After Cardiac Surgery.

  2020cites this paper
• Association Between Lactates, Blood Glucose, and Systemic Oxygen Delivery in Children After Cardiopulmonary Bypass

  2020cites this paper
• Prognostic value of peak lactate during cardiopulmonary bypass in adult cardiac surgeries: A retrospective cohort study

  2020cites this paper
• Effect of Pulsatile Cardiopulmonary Bypass in Adult Heart Surgery.

  2020cites this paper
• Hyperlactatemia during cardiopulmonary bypass: risk factors and impact on surgical results with a focus on the long-term outcome

  2020cites this paper
• Hyperlactatemia: An Update on Postoperative Lactate

  2020influential citation
• Cardiopulmonary Bypass

  2020cites this paper
• Unilateral or bilateral cerebral perfusion in hemiarch replacement: A prospective randomized study

  2020cites this paper
• Effects of intraoperative adrenergic administration on postoperative hyperlactatemia in open colon surgery: an observational study

  2020cites this paper
• Low Microcirculatory Perfused Vessel Density and High Heterogeneity are Associated With Increased Intensity and Duration of Lactic Acidosis After Cardiac Surgery with Cardiopulmonary Bypass

  2020cites this paper
• Effects of upper limb ischemia‐reperfusion on regional oxidative stress during aortic surgery with moderate hypothermia

  2020cites this paper
• Associations between oxygen delivery and cardiac index with hyperlactatemia during cardiopulmonary bypass

  2020cites this paper
• Continuous ultrafiltration during extracorporeal circulation and its effect on lactatemia: A randomized controlled trial

  2020cites this paper
• Our ultrafiltration experience in open heart surgery patients with chronic renal failure

  2020cites this paper
• Lower limit of adequate oxygen delivery for the maintenance of aerobic metabolism during cardiopulmonary bypass in neonates.

  2020cites this paper
• Optimal perfusion: Review based on recent scientific evidence

  2019cites this paper
• Clinical impact of intraoperative hyperlactatemia during craniotomy

  2019cites this paper
• Elevation of Intraoperative Lactate Levels During Cardiac Surgery: Is There Power in This Prognostication?

  2019cites this paper
• Lactate clearance in infants undergoing surgery for congenital heart disease

  2019cites this paper
• Intraoperative changes in blood lactate levels are associated with worse short-term outcomes after cardiac surgery with cardiopulmonary bypass

  2019cites this paper
• Association between admission lactate levels and mortality in patients with acute coronary syndrome: a retrospective cohort study

  2019cites this paper
• Evaluation of Increase in Intraoperative Lactate Level as a Predictor of Outcome in Adults After Cardiac Surgery.

  2019cites this paper
• A Quick Reference Tool for Goal-Directed Perfusion in Cardiac Surgery.

  2019influential citation
• Improved Estimation of Total Blood Volume Can Provide a Reliable Prediction of Dilutional Hematocrit and Oxygen Delivery during Cardiopulmonary Bypass.

  2019cites this paper
• The Expression of and Preoperative Correlation between Heat-Shock Protein 70, EuroSCORE, and Lactate in Patients undergoing CABG with Cardiopulmonary Bypass

  2019cites this paper
• Minimal volume ventilation during robotically assisted mitral valve surgery

  2019cites this paper
• Minimally invasive cardiac surgery – studies on immediate and mid-term outcomes

  2019cites this paper
• Evaluation of Blood Lactate Level as Predictor of Early Adverse Outcome after Cardiac Surgery under Cardiopulmonary Bypass

  2019cites this paper
• Assessing Predictive Value of Postoperative Elevated Lactate for Adverse Outcomes Following Hepatectomy

  2018cites this paper
• About differences in systemic and pulmonary circulation in the cases of metabolic acidosis after cardio surgery

  2018cites this paper
• Retrospective analysis of cardiac index and lactate production on cardiopulmonary bypass for a congenital cardiac patient population

  2018cites this paper
• Base excess is superior to lactate-levels in prediction of ICU mortality after cardiac surgery

  2018influential citation
• Recent innovations in perfusion and cardiopulmonary bypass for neonatal and infant cardiac surgery.

  2018cites this paper
• Goal-directed Cardiopulmonary Bypass Management in Pediatric Cardiac Surgery

  2018cites this paper
• Open Heart Surgery at Patient's Own Temperature Without Active Cooling.

  2018cites this paper
• Systemische Inflammation und Herzchirurgie

  2018cites this paper
• Blood Lactate Level as Predictor of Early Outcome after Cardiac Surgery under Cardiopulmonary Bypass

  2018cites this paper