Anaerobic Lactate Production Is Associated With Decreased Microcirculatory Blood Flow and Decreased Mitochondrial Respiration Following Cardiovascular Surgery With Cardiopulmonary Bypass.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
05 Apr 2024
05 Apr 2024
Historique:
medline:
5
4
2024
pubmed:
5
4
2024
entrez:
5
4
2024
Statut:
aheadofprint
Résumé
Quantify the relationship between perioperative anaerobic lactate production, microcirculatory blood flow, and mitochondrial respiration in patients after cardiovascular surgery with cardiopulmonary bypass. Serial measurements of lactate-pyruvate ratio (LPR), microcirculatory blood flow, plasma tricarboxylic acid cycle cycle intermediates, and mitochondrial respiration were compared between patients with a normal peak lactate (≤ 2 mmol/L) and a high peak lactate (≥ 4 mmol/L) in the first 6 hours after surgery. Regression analysis was performed to quantify the relationship between clinically relevant hemodynamic variables, lactate, LPR, and microcirculatory blood flow. This was a single-center, prospective observational study conducted in an academic cardiovascular ICU. One hundred thirty-two patients undergoing elective cardiovascular surgery with cardiopulmonary bypass. None. Patients with a high postoperative lactate were found to have a higher LPR compared with patients with a normal postoperative lactate (14.4 ± 2.5 vs. 11.7 ± 3.4; p = 0.005). Linear regression analysis found a significant, negative relationship between LPR and microcirculatory flow index (r = -0.225; β = -0.037; p = 0.001 and proportion of perfused vessels: r = -0.17; β = -0.468; p = 0.009). There was not a significant relationship between absolute plasma lactate and microcirculation variables. Last, mitochondrial complex I and complex II oxidative phosphorylation were reduced in patients with high postoperative lactate levels compared with patients with normal lactate (22.6 ± 6.2 vs. 14.5 ± 7.4 pmol O2/s/106 cells; p = 0.002). Increased anaerobic lactate production, estimated by LPR, has a negative relationship with microcirculatory blood flow after cardiovascular surgery. This relationship does not persist when measuring lactate alone. In addition, decreased mitochondrial respiration is associated with increased lactate after cardiovascular surgery. These findings suggest that high lactate levels after cardiovascular surgery, even in the setting of normal hemodynamics, are not simply a type B phenomenon as previously suggested.
Identifiants
pubmed: 38578158
doi: 10.1097/CCM.0000000000006289
pii: 00003246-990000000-00322
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
Drs. Greenwood, Jang, and Brenner received support for article research from the National Institutes of Health. Dr. Greenwood is supported by the National Center for Advancing Translational Sciences (award number KL2TR001879). Dr. Jang is supported by the National Heart, Lung, and Blood Institute (NHLBI; award number R01HL166592). Dr. Acker received funding from FineHeart. Dr. Kilbaugh is supported by the National Institutes of Congenital Heart Disease (award number R01HL141386). Dr. Brenner is supported by the NHLBI (award number R01HL153510). Dr. Brenner’s institution received funding from BioNTech, AltruMed, and Code BioTherapeutics. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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