PMID: 8968981Nov 1, 1996Paper

Lactate metabolism and regional lactate exchange after cardiac surgery

New Horizons : an Official Publication of the Society of Critical Care Medicine
Jukka TakalaEsko Ruokonen

Abstract

Tissue perfusion is at risk during cardiac surgery and in the immediate postoperative period. The association of low blood flow with metabolic acidosis and accumulation of lactate perioperatively has been well established. With the improvements in cardiopulmonary bypass and overall hemodynamic management, severe peri- and postoperative hypoperfusion has become rare. Despite the rarity of severe postoperative complications, several lines of evidence suggest that episodes of less severe hypoperfusion and borderline tissue oxygenation are relatively common, although generally well tolerated. Measurement of blood lactate levels is widely used to assess the adequacy of tissue perfusion. The interpretation of elevated blood lactate levels is limited by several confounding variables. Acute changes in acid-base balance, interorgan substrate flux, peripheral and visceral tissue perfusion, and hepatic lactate uptake will all influence blood lactate levels and may occur during and after cardiac surgery. Peri- and postoperative hyperlactatemia are rare occurrences and their presence may indicate inadequate tissue perfusion. Based on regional blood flow and lactate exchange measurements, we suggest that hyperlactatemia after cardiac surgery...Continue Reading

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