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Effect of cardiopulmonary bypass on lactate metabolism

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Abstract

Objective

We have investigated the role of cardiopulmonary bypass on lactate metabolism in patients undergoing uncomplicated surgery for elective coronary artery bypass grafting (CABG).

Design

Prospective non-randomized observational study.

Settings

National Cardiovascular Center.

Patients

Three independent groups were studied: preoperative (n=20), postoperative with bypass (CPB, n=20) and postoperative without bypass (NO-CPB, n=20).

Interventions

Lactate metabolism was investigated with the use of an exogenous lactate challenge test (2.5 mmol Na-lactate/kg body weight in 15 min). Blood lactate was sequentially determined after the end of infusion. Lactate clearance and endogenous production were estimated from the area under the curve, and a bi-exponential fitting permitted modeling the lactate-decay into two compartments.

Measurements and main results

Lactate metabolism parameters (basal lactate, clearance, endogenous production and half-lives [HL] I and II) were not different between the NO-CPB and preoperative groups. In the CPB group, as compared to the other two groups, basal lactate and endogenous production were not significantly affected while lactate clearance (CPB: 6.02±0.97 versus preoperative: 9.41±0.93 and NO-CPB: 9.6±0.8 ml/kg per min) and HL-I (CPB: 10.6±1.4 versus preoperative: 17.2±2.3 and NO-CPB: 18.8±2.5 min) were decreased (p<0.001) and HL-II was increased (CPB: 171±41versus preoperative: 73±12 and NO-CPB: 48±2.9 min, p<0.01).

Conclusion

While surgery and anesthesia per se do not seem to alter lactate metabolism, CPB significantly decreased lactate clearance, this effect being possibly related to a mild liver dysfunction even in uncomplicated elective surgery.

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Acknowledgement

The authors are indebted to Professor Bambang Sutrisna from the Department of Epidemiology, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia, for helpful discussions regarding the statistical evaluation of this work. Dr Christiane Keriel is acknowledged for help in correcting this manuscript.

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Authors and Affiliations

  1. Intensive Care Unit, Harapan Kita National Cardiovascular Center, Jakarta, Indonesia

    Iqbal Mustafa

  2. INSERM-E0221 Bioénergétique Fondamentale et Appliquée, Université Joseph Fourier et Département de Médecine Aiguë Spécialisée, Centre Hospitalier Universitaire de Grenoble, BP 53 X, 38041, Grenoble, France

    Hubert Roth & Xavier M. Leverve

  3. Department of Cardiology, Harapan Kita National Cardiovascular Center, Jakarta, Indonesia

    Asikin Hanafiah

  4. Department of Cardiothoracic Surgery, Harapan Kita National Cardiovascular Center, Jakarta , Indonesia

    Tarmizi Hakim & Maizul Anwar

  5. Department of Anesthesiology, Harapan Kita National Cardiovascular Center, Jakarta, Indonesia

    Erwin Siregar

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  1. Iqbal Mustafa
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Correspondence to Xavier M. Leverve.

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Mustafa, I., Roth, H., Hanafiah, A. et al. Effect of cardiopulmonary bypass on lactate metabolism. Intensive Care Med 29, 1279–1285 (2003). https://doi.org/10.1007/s00134-003-1860-6

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  • DOI: https://doi.org/10.1007/s00134-003-1860-6

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