title: Continuous Monitoring of Lactate Using Intravascular Microdialysis in High-Risk Cardiac Surgery: A Prospective Observational Study.
abstract: OBJECTIVE
  To assess the accuracy and applicability of a novel system, not requiring calibration, for continuous lactate monitoring with intravascular microdialysis in high-risk cardiac surgery.
  
  
  METHODS
  Single-center prospective observational study.
  
  
  METHODS
  City Hospital #1 of Arkhangelsk, Russian Federation.
  
  
  METHODS
  Twenty-one adult patients undergoing elective complex repair or replacement of two or more valves or combined valve and coronary artery cardiac surgery.
  
  
  METHODS
  After induction of anesthesia, in all patients a dedicated triple-lumen catheter functioning as a regular central venous catheter with integrated microdialysis function was inserted via the right jugular vein for continuous lactate monitoring using the intravascular microdialysis system.
  
  
  RESULTS
  Lactate values displayed by the microdialysis system were compared with the reference arterial blood gas (ABG) values. In total, 432 paired microdialysis-ABG lactate samples were obtained. After surgery, the concentration of lactate increased significantly, peaking at 8 hours (p<0.05). The lactate clearance within 8 hours after peak concentration was 50% (39%-63%). There was a significant correlation between Lactatecontand Lactatecont(rho = 0.92, p<0.0001). Bland-Altman analysis showed a bias (mean difference)±limits of agreement (±1.96 SD) of 0.09±1.1 mmol/L. In patients with postoperative complications, peak lactate concentration was significantly higher compared with those without complications: 6.75 (4.43-7.75) mmol/L, versus 4.20 (3.95-4.87) mmol/L (p = 0.002).
  
  
  CONCLUSIONS
  Lactate concentration increased significantly after high-risk cardiac surgery. The intravascular microdialysis technique for lactate measurement provided acceptable accuracy and can be used for continuous blood lactate monitoring in cardiac surgery.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation. Electronic address: bruber@mail.ru.
authors.forename: Pavel I
authors.initials: PI
authors.lastname: Lenkin
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation.
authors.forename: Alexey A
authors.initials: AA
authors.lastname: Smetkin
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation.
authors.forename: Ayyaz
authors.initials: A
authors.lastname: Hussain
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, City Hospital 1 of Arkhangelsk, Arkhangelsk, Russian Federation.
authors.forename: Andrey I
authors.initials: AI
authors.lastname: Lenkin
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, City Hospital 1 of Arkhangelsk, Arkhangelsk, Russian Federation.
authors.forename: Konstantin V
authors.initials: KV
authors.lastname: Paromov
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation.
authors.forename: Alexey A
authors.initials: AA
authors.lastname: Ushakov
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation.
authors.forename: Maria M
authors.initials: MM
authors.lastname: Krygina
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation.
authors.forename: Vsevolod V
authors.initials: VV
authors.lastname: Kuzkov
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Arkhangelsk, Russian Federation.
authors.forename: Mikhail Y
authors.initials: MY
authors.lastname: Kirov
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002405:Catheterization, Central Venous / Q000379:methods; D005260:Female; D006801:Humans; D065906:Hyperlactatemia / Q000175:diagnosis / Q000209:etiology; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D017551:Microdialysis / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D008991:Monitoring, Physiologic / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies
chemical_list: D019344:Lactic Acid
keywords: cardiac surgery; continuous monitoring; intravascular microdialysis; lactate; outcomes