Abstract
Objective
To evaluate the relationship between postoperative serum lactate levels and outcome in children undergoing open heart surgery.
Design
Prospective, noninterventional study.
Setting
Pediatric intensive care unit (PICU) of a university hospital.
Patients
41 nonconsecutive children who had had cardiopulmonary bypass for repair of congenital heart disease.
Interventions
None.
Measurements and results
Serum lactate levels were measured on admission to the PICU immediately after open heart surgery. Lactate levels were correlated with bypass and cross clamp times, estimated intraoperative blood loss, lowest temperature on bypass, admission Pediatric Risk of Mortality score, anion gap, and measures of postoperative morbidity. Mean lactate levels on admission to the PICU were 6.86±0.79 mmol/l for nonsurvivors (n=7) and 2.38±0.13 mmol/l for survivors (n=34) (p<0.0001), and 4.87±0.7 mmol/l and 2.35±0.19 mmol/l, for patients with (n=11) and without (n=30) multiple organ system failure, respectively (p<0.0001). Admission lactate levels correlated with all measurements of postoperative morbidity. A serum lactate level of greater than 4.2 mmol/l had a positive predictive value of 100% and a negative predictive value of 97% for postoperative death.
Conclusions
Initial postoperative serum lactate levels after pediatric open heart surgery may be predictive of outcome. Lactate levels are also higher in patients who go on to develop multiple organ system failure. Elevated postoperative lactate levels may reflect intraoperative tissue hypoperfusion, and measures aimed at increasing oxygen delivery, with normalization of lactate, may improve patient outcome.
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References
McGiffin DC, Kirklin JK (1994) Cardiopulmonary bypass, deep hypothermia and total circulatory arrest. In: Maroudis EC, Backer CL (eds) Pediatric cardiac surgery. Mosby, St. Louis, pp 115–129
Seghaye MC, Duchateau J, Grabitz RG (1993) Complement activation during cardiopulmonary bypass in infants and children. J Thorac Cardiovasc Surg 106:978–987
Kirklin JK, Westaby S, Blackstone EH (1983) Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg 86:845–857
Kirklin JK, Blackstone EH, Kirklin JW (1981) Intracardiac surgery in infants under age 3 months: incremental risk factors for hospital mortality. Am J Cardiol 48:500–506
Harris EA, Seelye ER, Barratt-Boyes BG (1970) Respiratory and metabolic acid-base changes during cardiopulmonary bypass in man. Br J Anaesth 42:912–921
Litwin MS, Panico FG, Rubini C (1959) Acidosis and lacticacidemia in extracorporeal circulation: the significance of perfusion flow rate and the relation to preperfusion respiratory alkalosis. Ann Surg 149:188–197
Fiaccadori E, Vezzani A, Coffrini E (1989) Cell metabolism in patients undergoing major valvular heart surgery: relationship with intra and postoperative hemodynamics, oxygen transport and oxygen utilization patterns. Crit Care Med 17:1286–1292
Ariza M, Gothard JWW, Macnaughton P (1991) Blood lactate and mixed venous-arterial pCO2 gradient as indices of poor peripheral perfusion following cardiopulmonary bypass surgery. Intensive Care Med 17:320–324
Schiavello R, Cavaliere F, Sollazzi (1984) Changes of serum pyruvate and lactate in open-heart surgery. Resuscitation 11:35–45
Chernow B, Aduen J, Bernstein WK (1995) Lactate: the ultimate blood test in critical care? In: Parker MM, Shapiro MJ, Porembka DT (eds) Critical care: state of the art. Society of Critical Care Medicine, pp 253–266
Bakker J, Coffernils M, Leon (1991) Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest 99:956–962
Pollack MM, Ruttimann UE, Getson PR (1988) Pediatric risk of mortality (PRISM) score. Crit Care Med 16:1110–1116
Vitek V, Cowley RA (1971) Blood lactate in the prognosis of various forms of shock. Ann Surg 173:308–313
Peretz DI, Scott HM, Duff J (1965) The significance of lacticacidemia in the shock syndrome. Ann NY Acad Sci 119:1133–1141
Iberti TJ, Leibowitz AB, Papadakos PJ (1990) Low sensitivity of the anion gap as a screen to detect hyperlactatemia in critically ill patients. Crit Care Med 18:275–277
Cheung PY, Finer NN (1994) Plasma lactate concentration as a predictor of death in neonates with severe hypoxemia requiring extracorporeal membrane oxygenation. J Pediatr 125:763–768
Vincent JL, Dufaye P, Berre J (1983) Serial lactate determinations during circulatory shock. Crit Care Med 11:449–451
Cowan BN, Burns HJG, Boyle P (1984) The relative prognostic value of lactate and haemodynamic measurements in early shock. Anaesthesia 39:750–755
Sumimoto T, Takayama Y, Iwasaka T (1991) Mixed venous oxygen saturation as a guide to tissue oxygenation and prognosis in patients with acute myocardial infarction. Am Heart J 122:27–33
Friedman G, Berlot G, Kahn R (1995) Combined measurements of blood lactate concentrations and gastric intramucosal pH in patients with severe sepsis. Crit Care Med 23:1184–1193
Abramson D, Scalea TM, Hitchcock R (1993) Lactate clearance and survival following injury. J Trauma 35:584–589
Rashkin MC, Bosken C, Baughman RP (1985) Oxygen delivery in critically ill patients: relationship to blood lactate and survival. Chest 87:580–584
Ernest D, Herkes RG, Raper RF (1992) Alterations in anion gap following cardiopulmonary bypass Crit Care Med 20:52–56
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Siegel, L.B., Dalton, H.J., Hertzog, J.H. et al. Initial postoperative serum lactate levels predict survival in children after open heart surgery. Intensive Care Med 22, 1418–1423 (1996). https://doi.org/10.1007/BF01709563
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DOI: https://doi.org/10.1007/BF01709563