Skip to main content
SpringerLink
Log in

Half-molar sodium-lactate solution has a beneficial effect in patients after coronary artery bypass grafting

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To compare two solutions for fluid resuscitation in post-coronary artery bypass grafting (CABG) surgery patients: Ringer’s lactate (RL) versus a new solution containing half-molar sodium-lactate (HL).

Design

Prospective randomized open label study.

Setting

The first 12 h post-CABG surgery in an intensive care unit (ICU).

Patients

There were 230 patients enrolled in the study: 208 were analyzed, with 109 from the HL group and 99 from the RL group.

Interventions

Patients received over the first 12 h post-CABG 10 ml kg BW−1 HL solution in the HL group versus 30 ml kg BW−1 of RL solution in the RL group.

Measurements and results

Hemodynamic status, body fluid balance and inotrope utilization were compared in the two groups. Post-operative cardiac index increase was significantly higher in HL than in RL (P = 0.02), while mean arterial pressure and other hemodynamic parameters were comparable together with urinary output, indicating similar tissue perfusion in both the groups despite a much lower fluid infusion in the HL group. Therefore, a significant negative fluid balance was achieved in the HL but not in the RL group (−790 ± 71 vs. +43 ± 115 mL 12 h−1, P < 0.0001 for HL and RL, respectively). None of the enrolled patients exhibited side effects related to the treatment.

Conclusion

Half-molar lactate solution is effective for fluid resuscitation in post-CABG patients. Compared to Ringer’s Lactate, its use results in a significantly higher cardiac index with less volume being infused, resulting in a very negative post-operative body fluid balance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Boldt J (2003) New light on intravascular volume replacement regimens: what did we learn from the past three years? Anesth Analg 97:1595–1604

    Article  PubMed  Google Scholar 

  2. Utley JR (1990) Pathophysiology of cardiopulmonary bypass: current issues. J Card Surg 5:177–189

    Article  PubMed  CAS  Google Scholar 

  3. Koller ME, Bert J, Segadal L, Reed RK (1992) Estimation of total body fluid shifts between plasma and interstitium in man during extracorporeal circulation. Acta Anaesthesiol Scand 36:255–259

    PubMed  CAS  Google Scholar 

  4. Stone JG, Hoar PF, Khambatta HJ (1983) Influence of volume loading on intraoperative hemodynamics and perioperative fluid retention in patients with valvular regurgitation undergoing prosthetic replacement. Am J Cardiol 52:530–533

    Article  PubMed  CAS  Google Scholar 

  5. Cross JS, Gruber DP, Burchard KW, Singh AK, Moran JM, Gann DS (1989) Hypertonic saline fluid therapy following surgery: a prospective study. J Trauma 29:817–825 Discussion 825–816

    PubMed  CAS  Google Scholar 

  6. Schierhout G, Roberts I (1998) Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials. BMJ 316:961–964

    PubMed  CAS  Google Scholar 

  7. Webb AR (1999) Crystalloid or colloid for resuscitation. Are we any the wiser? Crit Care 3:R25–R28

    Article  PubMed  Google Scholar 

  8. Boldt J (2005) Volume therapy in cardiac surgery. Ann Card Anaesth 8:104–116

    PubMed  CAS  Google Scholar 

  9. Moon PF, Hollyfield-Gilbert MA, Myers TL, Kramer GC (1994) Effects of isotonic crystalloid resuscitation on fluid compartments in hemorrhaged rats. Shock 2:355–361

    Article  PubMed  CAS  Google Scholar 

  10. Steele A, Gowrishankar M, Abrahamson S, Mazer CD, Feldman RD, Halperin ML (1997) Postoperative hyponatremia despite near-isotonic saline infusion: a phenomenon of desalination. Ann Intern Med 126:20–25

    PubMed  CAS  Google Scholar 

  11. Cross JS, Gruber DP, Gann DS, Singh AK, Moran JM, Burchard KW (1989) Hypertonic saline attenuates the hormonal response to injury. Ann Surg 209:684–691 Discussions 691–682

    Article  PubMed  CAS  Google Scholar 

  12. Velasco IT, Pontieri V, Rocha e Silva M, Lopes OU Jr (1980) Hyperosmotic NaCl and severe hemorrhagic shock. Am J Physiol 239:H664–H673

    PubMed  CAS  Google Scholar 

  13. Vassar MJ, Perry CA, Holcroft JW (1990) Analysis of potential risks associated with 7.5% sodium chloride resuscitation of traumatic shock. Arch Surg 125:1309–1315

    PubMed  CAS  Google Scholar 

  14. Reed RL 2nd, Johnston TD, Chen Y, Fischer RP (1991) Hypertonic saline alters plasma clotting times and platelet aggregation. J Trauma 31:8–14

    PubMed  Google Scholar 

  15. Huang PP, Stucky FS, Dimick AR, Treat RC, Bessey PQ, Rue LW (1995) Hypertonic sodium resuscitation is associated with renal failure and death. Ann Surg 221:543–554 (Discussion 554–547)

    Article  PubMed  CAS  Google Scholar 

  16. Mustafa I, Leverve XM (2002) Metabolic and hemodynamic effects of hypertonic solutions: sodium-lactate versus sodium chloride infusion in postoperative patients. Shock 18:306–310

    Article  PubMed  Google Scholar 

  17. Deitch EA, Shi HP, Feketeova E, Hauser CJ, Xu DZ (2003) Hypertonic saline resuscitation limits neutrophil activation after trauma-hemorrhagic shock. Shock 19:328–333

    Article  PubMed  Google Scholar 

  18. Bakker J, Gris P, Coffernils M, Kahn RJ, Vincent JL (1996) Serial blood lactate levels can predict the development of multiple organ failure following septic shock. Am J Surg 171:221–226

    Article  PubMed  CAS  Google Scholar 

  19. Munoz R, Laussen PC, Palacio G, Zienko L, Piercey G, Wessel DL (2000) Changes in whole blood lactate levels during cardiopulmonary bypass for surgery for congenital cardiac disease: an early indicator of morbidity and mortality. J Thorac Cardiovasc Surg 119:155–162

    Article  PubMed  CAS  Google Scholar 

  20. Chiolero RL, Revelly JP, Leverve X, Gersbach P, Cayeux MC, Berger MM, Tappy L (2000) Effects of cardiogenic shock on lactate and glucose metabolism after heart surgery. Crit Care Med 28:3784–3791

    Article  PubMed  CAS  Google Scholar 

  21. Leverve XM (1999) Energy metabolism in critically ill patients: lactate is a major oxidizable substrate. Curr Opin Clin Nutr Metab Care 2:165–169

    Article  PubMed  CAS  Google Scholar 

  22. Leverve X, Mustafa I, Péronnet F (1998) Pivotal role of lactate in aerobic metabolism. In: Yearbook of intensive care and emergency medicine. J. V. Springer, Berlin, pp 588–596

    Google Scholar 

  23. Mustafa I, Roth H, Hanafiah A, Hakim T, Anwar M, Siregar E, Leverve XM (2003) Effect of cardiopulmonary bypass on lactate metabolism. Intensive Care Med 29:1279–1285

    Article  PubMed  Google Scholar 

  24. Revelly JP, Tappy L, Martinez A, Bollmann M, Cayeux MC, Berger MM, Chiolero RL (2005) Lactate and glucose metabolism in severe sepsis and cardiogenic shock. Crit Care Med 33:2235–2240

    Article  PubMed  CAS  Google Scholar 

  25. King P, Kong MF, Parkin H, MacDonald IA, Barber C, Tattersall RB (1998) Intravenous lactate prevents cerebral dysfunction during hypoglycaemia in insulin-dependent diabetes mellitus. Clin Sci (Lond) 94:157–163

    CAS  Google Scholar 

  26. Maran A, Crepaldi C, Trupiani S, Lucca T, Jori E, Macdonald IA, Tiengo A, Avogaro A, Del Prato S (2000) Brain function rescue effect of lactate following hypoglycaemia is not an adaptation process in both normal and type I diabetic subjects. Diabetologia 43:733–741

    Article  PubMed  CAS  Google Scholar 

  27. Maran A, Cranston I, Lomas J, Macdonald I, Amiel SA (1994) Protection by lactate of cerebral function during hypoglycaemia. Lancet 343:16–20

    Article  PubMed  CAS  Google Scholar 

  28. Schurr A (2006) Lactate: the ultimate cerebral oxidative energy substrate? J Cereb Blood Flow Metab 26:142–152

    Article  PubMed  CAS  Google Scholar 

  29. Schurr A, Payne RS, Miller JJ, Rigor BM (1997) Brain lactate is an obligatory aerobic energy substrate for functional recovery after hypoxia: further in vitro validation. J Neurochem 69:423–426

    Article  PubMed  CAS  Google Scholar 

  30. Rice AC, Zsoldos R, Chen T, Wilson MS, Alessandri B, Hamm RJ, Bullock MR (2002) Lactate administration attenuates cognitive deficits following traumatic brain injury. Brain Res 928:156–159

    Article  PubMed  CAS  Google Scholar 

  31. Philp A, Macdonald AL, Watt PW (2005) Lactate—a signal coordinating cell and systemic function. J Exp Biol 208:4561–4575

    Article  PubMed  CAS  Google Scholar 

  32. Schurr A (2002) Lactate, glucose and energy metabolism in the ischemic brain (Review). Int J Mol Med 10:131–136

    PubMed  CAS  Google Scholar 

  33. Schurr A, Payne RS, Miller JJ, Rigor BM (1997) Brain lactate, not glucose, fuels the recovery of synaptic function from hypoxia upon reoxygenation: an in vitro study. Brain Res 744:105–111

    Article  PubMed  CAS  Google Scholar 

  34. Barbee RW, Kline JA, Watts JA (2000) Depletion of lactate by dichloroacetate reduces cardiac efficiency after hemorrhagic shock. Shock 14:208–214

    Article  PubMed  CAS  Google Scholar 

  35. Kline JA, Thornton LR, Lopaschuk GD, Barbee RW, Watts JA (2000) Lactate improves cardiac efficiency after hemorrhagic shock. Shock 14:215–221

    PubMed  CAS  Google Scholar 

  36. Levy B, Mansart A, Montemont C, Gibot S, Mallie JP, Regnault V, Lecompte T, Lacolley P (2007) Myocardial lactate deprivation is associated with decreased cardiovascular performance, decreased myocardial energetics, and early death in endotoxic shock. Intensive Care Med 33:495–502

    Article  PubMed  CAS  Google Scholar 

  37. Chiolero R, Tappy L, Gillet M, Revelly JP, Roth H, Cayeux C, Schneiter P, Leverve X (1999) Effect of major hepatectomy on glucose and lactate metabolism. Ann Surg 229:505–513

    Article  PubMed  CAS  Google Scholar 

  38. Connor H, Woods HF, Ledingham JG, Murray JD (1982) A model of L(+)-lactate metabolism in normal man. Ann Nutr Metab 26:254–263

    PubMed  CAS  Google Scholar 

  39. Lobo DN, Dube MG, Neal KR, Allison SP, Rowlands BJ (2002) Peri-operative fluid and electrolyte management: a survey of consultant surgeons in the UK. Ann R Coll Surg Engl 84:156–160

    PubMed  CAS  Google Scholar 

  40. Holte K, Sharrock NE, Kehlet H (2002) Pathophysiology and clinical implications of perioperative fluid excess. Br J Anaesth 89:622–632

    Article  PubMed  CAS  Google Scholar 

  41. Jarvela K, Kaukinen S (2002) Hypertonic saline (7.5%) decreases perioperative weight gain following cardiac surgery. J Cardiothorac Vasc Anesth 16:43–46

    Article  PubMed  Google Scholar 

  42. Jarvela K, Koskinen M, Kaukinen S, Koobi T (2001) Effects of hypertonic saline (7.5%) on extracellular fluid volumes compared with normal saline (0.9%) and 6% hydroxyethyl starch after aortocoronary bypass graft surgery. J Cardiothorac Vasc Anesth 15:210–215

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was sponsored by Innogene Kalbiotech, Pte. Ltd., 24 Raffles Place 27 – 06 Clifford Centre, Singapore 048621. The half-molar sodium-lactate containing solution is patented (WO 2004/096204 -11/11/04, Gazette 2004/46) and registered (Totilac™). We are grateful to Mr. Gareth Butt for his English corrections to this paper.

Disclosure of interest

Professor Xavier Leverve is member of the Innogene International Scientific Board Advisors.

Author information

Authors and Affiliations

  1. LBFA, INSERM-U884, Université Joseph-Fourier, BP 53 X, 38041, Grenoble Cedex, France

    Xavier M. Leverve

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

    Cindy Boon & Erwin Siregar

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

    Tarmizi Hakim & Maizul Anwar

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

    Iqbal Mustafa

Authors
  1. Xavier M. Leverve
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cindy Boon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tarmizi Hakim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maizul Anwar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erwin Siregar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Iqbal Mustafa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xavier M. Leverve.

Additional information

This clinical research work was performed at the Intensive Care Unit, Harapan Kita National Cardiovascular Center, Jakarta, Indonesia.

The present research work was the last clinical study carried out by Doctor Iqbal Mustafa, Head of the intensive care unit of Harapan Kita National Cardiovascular Center, shortly before he passed away so prematurely. This paper is dedicated to his memory and we hereby acknowledge the leading part he played in its realization.

This article is discussed in the editorial available at: doi:10.1007/s00134-008-1166-9.

Electronic supplementary material

Below is the link to the electronic supplementary material.

134_2008_1165_MOESM1_ESM.ppt

Fig. 1bis (electronic supplementary material). Effect of RL versus HL on heart rate, cardiac filling pressures, mean pulmonary artery pressure and vascular resistance. Open symbols: RL, closed symbols: HL. Panel A: Heart Rate (B/min); Panel B: Central Venous Pressure (CVP), mm Hg; panel C: Mean Pulmonary Artery Pressure (MPAP), mm Hg; Panel D: Pulmonary Artery Occluded Pressure (PAOP), mm Hg; panel E: Pulmonary Vascular Resistance Index (PVRI), dyne.s.cm−5; panel DF: Systemic Vascular Resistance Index (SVRI), dyne.s.cm−5. Results are expressed as means±sem; statistical comparisons with ANOVA for repeated measures: NS for all parameters, PVRI excepted: p=0.0367 (post hoc analysis: 2h p=0.004; 3h p=0.023; 5h p=0.011) (PPT 271 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leverve, X.M., Boon, C., Hakim, T. et al. Half-molar sodium-lactate solution has a beneficial effect in patients after coronary artery bypass grafting. Intensive Care Med 34, 1796–1803 (2008). https://doi.org/10.1007/s00134-008-1165-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-008-1165-x

Keywords

Search

Navigation