Changes in whole blood lactate levels during cardiopulmonary bypass for surgery for congenital cardiac disease: An early indicator of morbidity and mortality

Muñoz, Ricardo; Laussen, Peter C.; Palacio, Guillermo; Zienko, Lynne; Piercey, Gary; Wessel, David

doi:10.1016/s0022-5223(00)70231-5

Cited by 149 publications

(130 citation statements)

References 20 publications

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“…Munoz et al demonstrated that an increase in lactate level during CPB is an early indicator of a poor outcome (Munoz et al 2000). We showed that lactate measurements were more predictive of MAEs in the early post-CPB period.…”

Section: Fig 3 Periopetraive Hemodynamic Variables In the Mae Groupsupporting

confidence: 51%

“…Postoperative hyperlactatemia as a result of tissue hypoperfusion is associated with high morbidity and mortality, and the serum or plasma lactate level in the intensive care unit (ICU) has prognostic value after pediatric cardiac surgery (Cheifetz et al 1997;Charpie et al 2000, Cheung et al 2005, Basaran et al 2006). In addition, hyperlactatemia during cardiopulmonary bypass (CPB) is an early predictor of morbidity and mortality in pediatric patients (Munoz et al 2000, Ranucci et al 2006. However, some confounding factors, such as the inhibition of pyruvate dehydrogenase, enhanced glycolysis, and an exogenous lactate load from red blood cells, can decrease the predictive power of lactate levels (McAuliffe et al 1986, Gilfix et al 1993.…”

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confidence: 99%

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Intraoperative Plasma Lactate as an Early Indicator of Major Postoperative Events in Pediatric Cardiac Patients

Park

Kim

Byon

et al. 2012

Tohoku J. Exp. Med.

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Hyperlactatemia and unmeasured anions (UMA) have been suggested to be useful predictors of outcomes after pediatric cardiac surgery in the ICU. However, if we detect high-risk patient in the operating room, we could practice early intervention to decrease mortality and morbidity. The purpose of this study was to determine whether the intraoperative lactate or UMA levels can predict adverse outcomes in pediatric cardiac patients with undergoing cardiopulmonary bypass (CPB). We studied 102 patients with congenital heart disease. Arterial blood samples were obtained after inducing anesthesia, 5 min after weaning from CPB and after chest closure. Major adverse events (MAEs) were defined as cardiac compression, re-sternotomy due to hemodynamic instability, extra-corporeal membrane oxygenator support, creatinine levels greater than 2 mg/dL, or death. Patients were divided into MAE group (8 patients, 7.8%) and non-MAE group. Six patients with MAEs died. Importantly, the lactate levels (mmol/L) at weaning from CPB (4.19 vs 2.1; MAE group vs non-MAE group), chest closure (5.76 vs 2.39; MAE group vs non-MAE group) and the intraoperative increases in lactate levels were significantly higher in the MAE group than in the non-MAE group. However, there was no significant difference in the UMA levels or their changes between the groups. The increase in the lactate level from CPB weaning to chest closure was the best predictor of MAEs (AUC: 0.810). In conclusion, the intraoperative plasma lactate levels were more closely associated with MAEs, and they are more useful for predicting the outcome of pediatric cardiac patients than the UMA levels.

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Section: Fig 3 Periopetraive Hemodynamic Variables In the Mae Groupsupporting

confidence: 51%

mentioning

confidence: 99%

Intraoperative Plasma Lactate as an Early Indicator of Major Postoperative Events in Pediatric Cardiac Patients

Park

Kim

Byon

et al. 2012

Tohoku J. Exp. Med.

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“…[14][15][16] Shemie [14] reported that major complications occurred in 32 of 109 patients, and that lactate levels were higher in patients with complications (8.6±6.1 mmol/L vs 3.2±1.9 mmol/L). Duke et al [15] reported 12 serious complications in 90 pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac output within the first 24 hours, oxygen delivery, mixed venous oxygen saturation, heart rate, and the difference of peripheral-central temperature did not have an effect on major adverse events. Munoz et al [16] investigated the arterial lactate levels before, during (cooling and warming-up), and after CPB, and upon ICU admission. Serious complications were defined as transfer to the intensive care unit with open sternum, development of renal failure, cardiac arrest, and requirement of resuscitation, requirement for ECMO, and death.…”

Section: Discussionmentioning

confidence: 99%

Correlation between serum lactate levels and outcome in pediatric patients undergoing congenital heart surgery

Şahutoğlu

Yaşar

Kocabas

et al. 2018

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada doğuştan kalp cerrahisi geçiren pediatrik hastalarda perioperatif arteriyal laktat düzeyleri ile mortalite ve morbidite arasında ilişki olup olmadığı araştırıldı.Ça lış m a pla nı: Haziran 2014-Mayıs 2016 tarihleri arasında doğuştan kalp cerrahisi geçiren 236 hasta (121 erkek, 115 kadın; ort. yaş 56.4 ay (median: 42 ay): dağılım, 1 gün-204 ay) retrospektif olarak değerlendirildi. Başlangıçta (arter kanülü uygulandıktan sonra), kardiyopulmoner baypas soğuma ve ısınma fazında, sternum kapatılması aşamasında ve ameliyat sonrası yoğun bakım kalış süresi 0, 6, 12. ve 24. saatlerdeki arteriyel kan gazı analizleri kaydedildi. Hastalar laktat düzeylerine göre iki gruba ayrıldı: (Grup 1 laktat düzeyi <4.5 mmol/L, n=183; Grup 2 laktat düzeyi ≥4.5 mmol/L, n=53). Gruplar ile hastaların demografik verileri, ameliyat sırası ve ameliyat sonrası değişkenler, komplikasyonlar ve mortalite arasındaki ilişki araştırıldı. Bul gu lar:Altmış dokuz hastada (%29.2) siyanotik kalp hastalığı vardı. Toplamda 53 hastada (%22.5) laktat düzeyi 4.5 mmol/L ve üzerinde idi. Hastaların %41'inde en az bir komplikasyon gelişti. Laktat düzeyi ≥4.5 mmol/L grupta en az bir komplikasyon gelişimi (p= 0.027) ve mortalite oranı (p<0.001) anlamlı olarak daha yüksekti. On yedi hasta (%7.2) ameliyat sonrası dönemde kaybedildi ve bu hastaların 15'inde laktat düzeyi ilk 24 saatte en az bir kez ≥4.5 mmol/L idi. Herhangi bir dönemde laktat düzeylerinin ≥4.5 mmol/L olması, uzamış mekanik ventilasyon (>48 saat) ve hastanın kompleks cerrahi geçirmesi (yüksek Risk-adjusted Classification for Congenital Heart Surgery-1 skoru, kategori 4-6) mortalite için bağımsız risk faktörü olarak tespit edildi.So nuç:Doğuştan kalp cerrahisi uygulanan çocuk hastalarda, arteriyel laktat düzeyinin 4.5 mmol/L veya üzerinde olmasının ameliyat sonrası morbidite ve mortalite için bağımsız risk faktörü olduğu saptandı.Anah tarsöz cük ler: Kardiyak cerrahi; doğuştan; kalp kusurları; laktat; ölüm oranı; ameliyat sonrası komplikasyonlar ABSTRACT Background: This study aimed to investigate the correlation between perioperative arterial lactate levels and morbidity and mortality in children undergoing cardiac surgery.

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“…Не вызывает сомне ний, что тканевая гипоксия, в частности проявляющая ся гиперлактатемией, достоверно повышает риск осложнений после операций с ИК [10][11][12][13]. Вместе с тем, детальные исследования центральной гемодина мики (ЦГД) и ТК при разном темпе послеоперацион ной активизации до настоящего времени отсутствуют.…”

Section: центральная гемодинамика и транспорт кислорода при разном теunclassified

Central Hemodynamics and Oxygen Transport in Various Activation of Patients Operated On Under Extracorporeal Circulation

Дзыбинская¹,

Ivanina²,

Kozlov³

2009

rmt

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О Б Щ А Я Р Е А Н И М А Т О Л О Г И Я , 2 0 0 9 , V ; 1 74 www.niiorramn.ruЦель исследования -изучить центральную гемодинамику, детерминанты кислородного баланса миокарда и параметры транспорта кислорода при различном темпе активизации больных после операций с искусственным кровообращением. Ма териал и методы. Обследовали 34 больных ишемической болезнью сердца в возрасте 57,8±2,5 года, разделенных на 2 груп пы: 1 я -с отсроченной активизацией (время искусственной вентиляции легких -157±9 мин) и 2 я -с немедленной акти визацией (время искусственной вентиляции легких -33±6 мин). При необходимости больным 2 й группы назначали антагонисты фентанила, мидазолама и миорелаксантов. Результаты. Во время активизации не было межгрупповых отли чий в среднем уровне основных параметров насосной функции сердца, детерминантах коронарного кровотока (коронарные перфузионные градиенты) и потребности миокарда в кислороде (произведение частоты сердечных сокращений на систоли ческое артериальное давление), а также показателях транспорта кислорода, включая артериальную лактатемию. После экс тубации трахеи существенно (р<0,05) возрастал насосный коэффициент левого желудочка (в 1 й группе до 3,8±0,2, во 2 й -до 4,4±0,2 гм/мм рт. ст./м 2 ) при минимальной инотропной поддержке (расход допамина и/или добутамина 2,7±0,3 и 2,4±0,3 мкг/кг/мин, соответственно). В обеих группах на всех этапах исследования не было тесных корреляционных связей между индексами доставки и потребления кислорода, что свидетельствует об отсутствии «транспорт зависимого» потреб ления кислорода. Заключение: при тщательном соблюдении протокола ранней активизации, максимальное ускорение по следней, в том числе путем назначения специфических антагонистов анестезиологических препаратов, не оказывает отри цательного влияния на центральную гемодинамику, детерминанты кислородного баланса миокарда и транспорт кислорода у больных, оперированных с искусственным кровообращением. Ключевые слова: ранняя активизация, операции с искусст венным кровообращением, экстубация трахеи в операционной, центральная гемодинамика, транспорт кислорода.Objective: to study central hemodynamics, the determinants of myocardial oxygen balance, and the parameters of oxygen trans port in various activation of patients after surgery under extracorporeal circulation. Subjects and methods. Thirty four patients aged 57.8±2.5 years who had coronary heart disease were divided into 2 groups: 1) those with late activation (artificial ventilation time 157±9 min) and 2) those with immediate activation (artificial ventilation time 33±6 min). Group 2 patients were, if required, given fentanyl, midazolam, or myorelaxants. Results. During activation, there were no intergroup differences in the mean levels of the major parameters of cardiac pump function, in the determinants of coronary blood flow (coronary perfusion gradients) and myocardial oxygen demand (the product of heart rate by systolic blood pressure), and in the parameters of oxygen transport, including arterial lactatemia. After tracheal extubation, the left...

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Changes in whole blood lactate levels during cardiopulmonary bypass for surgery for congenital cardiac disease: An early indicator of morbidity and mortality

Abstract: Hyperlactatemia occurs during cardiopulmonary bypass in patients undergoing operations for congenital cardiac disease and may be an early indicator for postoperative morbidity and mortality.

Cited by 149 publications

References 20 publications

Intraoperative Plasma Lactate as an Early Indicator of Major Postoperative Events in Pediatric Cardiac Patients

Intraoperative Plasma Lactate as an Early Indicator of Major Postoperative Events in Pediatric Cardiac Patients

Correlation between serum lactate levels and outcome in pediatric patients undergoing congenital heart surgery

Central Hemodynamics and Oxygen Transport in Various Activation of Patients Operated On Under Extracorporeal Circulation

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