Rethinking Lactate in Cardiac Surgery and Intensive Care

Authors

• John Guzzi, Department of Anesthesiology, Yale School of Medicine, New Haven, CT.
• Ryan Salter, Wellington Regional Hospital, Wellington, New Zealand.
• Stephen Pettit, Royal Papworth Hospital, Cambridge, United Kingdom.
• Tyler Kelting, Perfusion Services, MaineHealth, Portland, ME.
• Florian Falter, Department of Anesthesiology and Critical Care, Royal Papworth Hospital, Cambridge, United Kingdom.
• Albert C. Perrino, Department of Anesthesiology, Yale School of Medicine, New Haven, CT; Department of Anesthesiology, Veterans Affairs Connecticut Healthcare System, West Haven, CT.

Document Type

Article

Publication Date

7-2026

Institution/Department

Surgery

Journal Title

Journal of cardiothoracic and vascular anesthesia

MeSH Headings

Humans; Cardiac Surgical Procedures (methods, trends); Critical Care (methods, trends); Lactic Acid (blood); Hyperlactatemia (blood); Cardiopulmonary Bypass; Monitoring, Intraoperative (methods)

Abstract

Lactate has traditionally been framed as a by-product of anaerobic metabolism and a surrogate for tissue hypoxia. Contemporary physiology recasts lactate as a central fuel, shuttle, and signaling molecule, challenging long-held interpretations in cardiac surgery and intensive care. This narrative review synthesizes evidence across exercise physiology, biochemistry, cardiac anesthesia, and intensive care to reinterpret perioperative hyperlactatemia during cardiopulmonary bypass and after cardiac surgery and highlights emerging opportunities in continuous lactate monitoring.

First Page

2177

Last Page

2190

Recommended Citation

Guzzi, John; Salter, Ryan; Pettit, Stephen; Kelting, Tyler; Falter, Florian; and Perrino, Albert C., "Rethinking Lactate in Cardiac Surgery and Intensive Care" (2026). MaineHealth Maine Medical Center. 4558.
https://knowledgeconnection.mainehealth.org/mmc/4558