From the Research
Elevated lactate levels are not a normal post-operative finding and should prompt further investigation. While mild, transient elevations in lactate can occur during surgery due to tissue hypoxia from anesthesia or surgical stress, persistent or significantly elevated lactate levels (>2 mmol/L) after surgery suggest inadequate tissue perfusion or oxygenation 1. Common causes include hypovolemia, sepsis, cardiac dysfunction, respiratory insufficiency, or medication effects. Management involves identifying and treating the underlying cause, which may include fluid resuscitation, improving oxygen delivery, treating infection, or adjusting medications.
Key Points to Consider
- Serial lactate measurements are valuable for monitoring response to treatment, with decreasing levels indicating improvement 2.
- Elevated lactate is concerning because it reflects anaerobic metabolism occurring when tissues don't receive adequate oxygen, potentially leading to organ dysfunction if not addressed promptly.
- Any persistent elevation should trigger a systematic evaluation of the patient's hemodynamic status, respiratory function, and potential sources of infection.
- The optimal cut-off point for lactate levels to predict in-hospital mortality among heart transplant recipients is estimated at 7.0 mmol/L 1.
- The dynamic changes in blood lactate levels during the first 24 postoperative hours were significantly associated with complications after major elective abdominal surgery 2.
Recommendations for Clinical Practice
- Monitor lactate levels closely in the post-operative period, especially in high-risk patients.
- Investigate and address any underlying causes of elevated lactate levels promptly.
- Use serial lactate measurements to guide treatment and assess response to intervention.
- Consider the optimal cut-off point for lactate levels in different patient populations to predict in-hospital mortality and complications.