Intraoperative Lactate Level as a Predictor of Resuscitation in Open Cranial Vault Reconstruction

Area of Science:

• Neurosurgery
• Anesthesiology
• Critical Care Medicine

Background:

• Open cranial vault reconstructions (CVR) carry risks of significant blood loss, necessitating effective resuscitation.
• Traditional resuscitation metrics like heart rate (HR) and mean arterial pressure (MAP) may not adequately reflect cellular hypoxia.
• Lactate levels are recognized as more sensitive indicators of tissue oxygenation than standard vital signs.

Purpose of the Study:

• To investigate the correlation between intraoperative physiological markers of resuscitation and lactate levels in patients undergoing CVR.
• To determine if conventional hemodynamic parameters accurately predict elevated intraoperative lactate.

Main Methods:

• A retrospective review of 148 patients who underwent CVR between 2013 and 2021 was performed.
• Intraoperative data, including lactate levels, HR, MAP, and urine output (UO), were collected and analyzed.
• Statistical analysis assessed correlations between lactate levels and physiological parameters, as well as patient characteristics.

Main Results:

• Elevated intraoperative lactate (hyperlactatemia) occurred in 17.6% of cases.
• Hyperlactatemia did not correlate with HR or MAP.
• Increased patient weight, decreased preoperative hematocrit, and reduced UO were associated with higher odds of hyperlactatemia.

Conclusions:

• Intraoperative lactate levels in CVR patients do not directly correlate with standard hemodynamic stability measures.
• Hyperlactatemia is inversely associated with UO and hematocrit, highlighting their importance in resuscitation.
• Reliance solely on vital signs for assessing resuscitation adequacy during CVR may be insufficient; optimizing UO and hematocrit is crucial.