2020, Number 2
<< Back Next >>
Invest Medicoquir 2020; 12 (2)
Mythes and realities about the behavior of lactate in patients undergoing extracorporeal circulation
Miguel VY, Alvarez PA, De Zayas GJ, Leiva TJL
Language: Spanish
References: 41
Page:
PDF size: 496.54 Kb.
ABSTRACT
The interpretation, analysis and management strategies of lactate in patients undergoing Extracorporeal Circulation during the last decade has changed, due to the advent of new measurement technologies and deep understanding of the metabolism of carbohydrates in humans, this molecule has changed from being just a villain to an alternative source of energy in special physiological moments, one of them being the Extracorporeal Circulation, in which the neuroendocrine response to stress and the inflammatory response to contact of a non-endothelialized surface biologically, make the responses and biochemical manifestations not fully understood. The molecule of lactate and its increases in Extracorporeal Circulation, does not escape this response, its bimodal presentation and its normalization in the short term, has generated many times misguided approaches by the specialists involved in the entire perioperative process of the patient submitted to Extracorporeal Circulation. The main focus of this review is to clarify the myths and show the real facts in the light of current knowledge.
REFERENCES
Kompanje EJ, Jansen TC, van der Hoven B, Bakker J. The first demonstration of lactic acid in human blood in shock by Johann Joseph Scherer (1814–1869) in January 1843. Intensive Care Med. 2007;33:1967–1971.
Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, Tomlanovich MC. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004;32:1637–1642.
Arnold RC, Shapiro NI, Jones AE, Schorr C, Pope J, Casner E, Parrillo JE, Dellinger RP, Trzeciak S. Multicenter study of early lactate clearance as a determinant of survival in patients with presumed sepsis. Shock. 2009;32:35–39.
O’Connor E, Fraser JF. The interpretation of perioperative lactate abnormalities in patients undergoing cardiac surgery. Anaesth Intensive Care. 2012;40:598–603.
De Backer D, Dubois MJ, Schmartz D, Koch M, Ducart A, Barvais L, Vincent JL. Microcirculatory alterations in cardiac surgery: effects of cardiopulmonary bypass and anesthesia. Ann Thorac Surg. 2009 Nov;88(5):1396-403.
Volk T, Schmutzler M, Engelhardt L, et al. Influence of aminosteroid and glucocorticoid treatment on inflammation and immune function during cardiopulmonary bypass. Crit Care Med. 2001;29:2137– 42.
Van der Linden PJ, De Hert SG, Belisle S, et al. Critical oxygen delivery during cardiopulmonary bypass in dogs: pulsatile vs. non-pulsatile blood flow. Eur J Anaesthesiol. 2006;23:10-16
American Society of Extracorporeal Technology [Internet]. Chicago [citado 2018 mayo]. Standards and clinical practice guidelines. [Aproximandamente 2 pantallas]. Disponible en: http://www.amsect.org/page/standards-and-guidelines-1117
Gold JP, Et al Improvement of outcomes after coronary artery bypass. A randomized trial comparing intraoperative high versus low mean arterial pressure. J Thorac Cardiovasc Surg. 1995;110:1302–11.
Ranucci M, Romitti F, Isgro G, et al. Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations.Ann Thorac Surg. 2005;80:2213–20.
Parolari A, Et al. Cardiopulmonary bypass and oxygen consumption: oxygen delivery and hemodynamics. Ann Thorac Surg. 1999;67:1320–7.
The Warm Heart Investigators. Randomized trial of normothermic versus hypothermic coronary bypass surgery. Lancet.1994;343:559–63.
Nathan HJ, Et al. Neuroprotective effect of mild hypothermia in patients undergoing coronary artery surgery with cardiopulmonary bypass: five-year follow-up of a randomized trial. J Thorac Cardiovasc Surg. 2007;133:1206–11.
Ji B, Undar A. An evaluation of the benefits of pulsatile versus nonpulsatile perfusion during cardiopulmonary bypass procedures in pediatric and adult cardiac patients. ASAIO J. 2006;52:357–611.
Mangoush O, Et al. Heparin-bonded circuits versus nonheparin-bonded circuits: an evaluation of their effect on clinical outcomes. Eur J Cardiothorac Surg. 2007;31:1058–69.
Shann KG, Likosky DS, Murkin JM, Baker RA, Baribeau YR,DeFoe GR, et al. An evidence-based review of the practice of cardiopulmonary bypass in adults: a focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response. J Thorac Cardiovasc Surg. 2006;132(2):283–90.
BeeBee Y. Hu, Greg A. Laine et al. Combined Central Venous Oxygen Saturation and Lactate as Markers of Occult Hypoperfusion and Outcome Following Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2012;26(1): 52-57.
St André AC, DelRossi A: Hemodynamic management of patients in the first 24 hours after cardiac surgery. Crit Care Med. 2005;33:2082-93.
Astles R, Williams CP, Sedor F: Stability of plasma lactate in vitro in the presence of antiglycolytic agents. Clin Chem. 1994;40:1327-30.
Ryan, T., Balding, J., McGovern, E. M., Hinchion, J., Livingstone, W., Chughtai, Z., & Smith, O. P. Lactic acidosis after cardiac surgery is associated with polymorphisms in tumor necrosis factor and interleukin 10 genes. The Annals of Thoracic Surgery. 2002;73(6):1905-09.
Riha, H., Hubacek, J. A., Poledne, R., Kellovsky, P., Brezina, A., & Pirk, J. IL-10 and TNF-beta gene polymorphisms have no major influence on lactate levels after cardiac surgery. European Journal of Cardio-Thoracic Surgery. 2006;30(1):54-58.
Duke Anesthesiology. [Internet]. Duke: Duke University School of Medicine; c2018 [citado 2018 mayo]. Perioperative genetics and safety outcomes study (PEGASUS);[aproximadamente 2 pantallas]. Disponible en: https://anesthesiology.duke.edu/?page_id=539316
Adeva-Andany M, Lopez-Ojen M, Funcasta-Calderon R, et al. Comprehensive review on lactate metabolism in human health. Mitochondrion. 2014;17:76-100.
O’Connor E, Fraser JF. The interpretation of perioperative lactate abnormalities in patients undergoing cardiac surgery. Anaesth Intensive Care. 2012;40:598-603.
Maillet JM, Le Besnerais P, Cantoni M, et al. Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery. Chest. 2003;123:1361-6.
Jansen TC, van Bommel J, Schoonderbeek FJ, et al; LACTATE Study Group. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized con-trolled trial. Am J Respir Crit Care Med. 2010;182:752–761.
Alam, J. M., Hussain, A., Ali, H. H., Asghar, S. S., & Mahmood, S. R. Study on Significant Correlation of Postoperative Hyperlactatemia with Poor Prognosis in Cardiac Surgery Patients. International Journal of Pharma Research and Health Sciences. 2016;4(3):1223-28.
Heringlake M, Bahlmann L, Misfeld M, et al. High myocardial lactate concentration is associated with poor myocardial function prior to cardiopulmonary bypass. Minerva Anestesiol. 2005;71:775-83.
Kapoor P, Mandal B, Chowdhury U, Singh S, Kiran U. Changes in myocardial lactate, pyruvate and lactate-pyruvate ratio during cardiopulmonary bypass for elective adult cardiac surgery: Early indicator of morbidity. J Anaesthesiol Clin Pharmacol. 2011;27:225-32.
Pojar M, Mand’ak J, Cibicek N, et al. Peripheral tissue metabolism during off-pump versus on-pump coronary artery bypass graft surgery: The microdialysis study. Eur J Cardiothorac Surg. 2008;33:899-905.
Minton, J., & Sidebotham, D. A. Hyperlactatemia and Cardiac Surgery. The Journal of Extra-Corporeal Technology. 2016;49(1),7-15.
Totaro R. J., Raper R. F. Epinephrine-induced lactic acidosis following cardiopulmonary bypass. Crit Care Med. 1997;25:1693-9.
O'Connor E. D., Fraser J. F. Hyperlactatemia in critical illness and cardiac surgery. Crit Care. 2010;14:421.
Haanschoten, M. C., Kreeftenberg, H. G., Arthur Bouwman, R., van Straten, A. H. M., Buhre, W. F., & Soliman Hamad, M. A. Use of Postoperative Peak Arterial Lactate Level to Predict Outcome After Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2017;31(1),45-53.
Gomez, H. Mizok B.A. Hyperlactatemia and Lactic Acidosis. In: Ronco et al, editores. Critical Care Nephrology.3th ed. Philadelphia: Elsevier; 2017. p. 394-404.
Van Hall G. Lactate kinetics in human tissues at rest and during exercise. Acta Physiol(Oxf). 2010;199(4):499-508.
Mizock BA. Alterations in carbohydrate metabolism during stress: a review of the literature. Am J Med. 1995;98(1):75-84.
Cersosimo E, Garlick P, Ferretti J. Renal substrate metabolism and gluconeogenesis during hypoglycemia in humans. Diabetes. 2000;49(7):1186-93.
Brooks GA. Mammalian fuel utilization during sustained exercise. Comp Biochem Physiol B Biochem Mol Biol. 1998;120(1):89-107.
Brooks GA, Dubouchaud H, Brown M, et al. Role of mitochondrial lactate dehydrogenase and lactate oxidation in the intracellular lactate shuttle. Proc Natl Acad Sci. 1999;96(3):1129-34.
Ince C. Hemodynamic coherence and the rationale for monitoring the microcirculation. Crit Care. 2015;19(Suppl. 3):S8.