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Sequential perioperative lactate determination. Physiological and clinical implications

K Waxman, L S Nolan, W C Shoemaker

    Critical Care Medicine
    |February 1, 1982
    PubMed
    Summary
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    Intraoperative lactate levels in high-risk surgical patients increased, correlating with decreased oxygen consumption (VO2). Postoperative lactate elevations may indicate oxygen deficits, guiding therapy to support physiological compensation.

    Area of Science:

    • Cardiovascular Physiology
    • Metabolic Monitoring
    • Surgical Patient Management

    Background:

    • Lactate accumulation is a marker of anaerobic metabolism.
    • Monitoring physiological parameters is crucial in high-risk surgery.
    • Understanding oxygen debt is vital for patient recovery.

    Purpose of the Study:

    • To investigate the relationship between arterial lactate levels and hemodynamic/metabolic parameters during high-risk surgery.
    • To determine if intraoperative lactate changes correlate with oxygen consumption and blood pressure.
    • To assess the clinical utility of lactate measurements in guiding postoperative care.

    Main Methods:

    • Sequential arterial blood lactate measurements were taken pre-, intra-, and postoperatively.
    • Simultaneous measurements of arterial blood pressure, cardiac index (CI), and oxygen consumption (VO2) were recorded.

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  • Data from 12 high-risk surgical patients were analyzed for correlations.

    • Main Results:

    • A significant increase in lactate levels was observed intraoperatively.
    • Intraoperative lactate increases correlated with decreased VO2, but not with mean arterial pressure (MAP) or CI.
    • Postoperative elevated lactate levels correlated with estimated intraoperative oxygen deficit.

    Conclusions:

    • Intraoperative lactate elevation in high-risk surgery is linked to reduced oxygen consumption.
    • Postoperative lactate levels may reflect intraoperative oxygen deficits, guiding compensatory physiological responses.
    • Lactate monitoring can aid in titrating postoperative therapy to support patient recovery.