Factors associated with increased lactate levels in cardiac surgeries: scoping review.
Fernanda de Castro Teixeira, Thatiane Evelyn de Lima Fernandes, Karena Cristina da Silva Leal and 3 others
PMID 38511788WHAT IT FOUND
Long bypass times and tissue hypoperfusion drive high lactate after cardiac surgery.
Lactate above 4 mmol/L predicts mortality, but this is a warning sign of stress, not proof the heart is failing. Monitor perfusion and bypass duration.
Key findings
01The most frequent factors associated with increased postoperative lactate were tissue hypoperfusion, long cardiopulmonary bypass time, and corticosteroid use.
02A lactate level above 4 mmol/L is associated with greater postoperative complications and higher mortality.
03Increased lactate is a multifactorial response to stress, not solely a reflection of tissue hypoperfusion.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only 19 studies, most of which were observational, limiting the strength of the evidence. The authors noted that not all factors were investigated in specific, in-depth studies. There was a scarcity of clinical trials focused on this topic. The definition of 'increased lactate' varied across the included studies.
The easy way to misread this
Do not assume that high lactate always means the patient's heart is failing or that tissue perfusion is critically low. The review states that lactate elevation is a multifactorial stress response, which can be caused by medications like corticosteroids or epinephrine, independent of oxygen delivery.