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Factors affecting on serum lactate after cardiac surgery
Marjan Joudi1, Mehdi Fathi1, Ghasem Soltani2
1Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
The number of blood units transfused significantly impacts serum lactate levels after cardiac surgery. Blood storage duration did not show a significant effect on lactate levels in this study.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Critical Care Medicine
Background:
- Elevated blood lactate levels correlate with increased mortality and morbidity post-coronary bypass surgery.
- Packed red blood cell storage duration is a potential factor influencing blood lactate levels.
Purpose of the Study:
- To investigate the impact of transfused blood storage duration on serum lactate levels during and after cardiac surgery.
- To assess serum lactate levels up to 24 hours post-surgery in the Intensive Care Unit (ICU).
Main Methods:
- A cross-sectional study involving 228 patients undergoing open cardiac surgery.
- Systematic random sampling was used for patient enrollment.
- Arterial blood gas samples were collected pre-operatively, at the end of surgery, and 24 hours post-surgery in the ICU.
Main Results:
- Diabetes and higher ejection fraction (EF) were associated with reduced lactate level changes during surgery.
- Increased infused blood units, longer on-pump time, and longer blood unit storage duration correlated with elevated intraoperative serum lactate.
- A significant association was observed between blood storage duration and serum lactate levels 24 hours post-surgery.
Conclusions:
- The number of blood units transfused significantly affects postoperative serum lactate levels.
- Blood storage duration did not demonstrate a significant impact on serum lactate levels.
- The quantity of transfused blood units emerged as a more significant factor influencing serum lactate compared to storage duration.
Background:
The relation between elevated blood lactate level and mortality and morbidity rates after coronary bypass surgery is a proven subject. One of the factors that seems to affect directly the blood lactate level is the storage duration of packed red blood cells.
Objectives:
This study aimed to evaluate the effect of storage duration of transfused blood on serum lactate during cardiac surgery and up to 24 hours after that in the ICU.
Patients And Methods:
In a cross-sectional study, 228 patients referred to three hospitals of Mashhad University of Medical Sciences for open cardiac surgery, was enrolled using systematic random sampling method. Immediately after accessing arterial line, the first sample of arterial blood gas (ABG) was obtained. For evaluation of lactate levels, the next samples were obtained at the end of surgery and after 24 hours of staying ICU.
Results:
Among 5 factors which affected lactate level during surgery, diabetes and higher ejection fraction (EF) reduced changes of the lactate level. On the other hand, the number of infused blood units, duration of on-pump time, and the mean storage duration of blood units were associated with elevated serum lactate during surgery. A significant relationship was found between blood storage duration and serum lactate levels 24 hours after surgery.
Conclusions:
Comparing the serum lactate level before operation and 24 hours after the operation showed that the number of received blood units had a significant effect on serum lactate. We found no significant effect for blood storage duration; however, the number of given blood units was more significant.
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