Predictors of Increased Lactate in Neonatal Cardiac Surgery: The Impact of Cardiopulmonary Bypass

Blood pressure and flow in pediatric anesthesia: An educational review

“…From this perspective, it is reasonable to state that blood pressure primarily has a role in driving the flow between two points and that it is the difference between the points rather than the inherent values of the points that are decisive. A telling example of this is that the perfusion pressure, when on pediatric cardiopulmonary bypass, frequently is initially set at approximately 30 mmHg, again a MABP level that is considered very low by many 12,13 . This example is admittedly extreme, but it does go to show that it is flow and not pressure that is a key determinant for ensuring a satisfactory balance between oxygen delivery and consumption.…”

Predicting Lactate Elevation in Neonatal Cardiac Surgery: Can the Sugars be Overlooked?

“…We read with great interest the retrospective study by Nasr et al evaluating the predictors of increased lactate in a neonatal cardiac surgical setting. 1 The study meticulously employs regression models to eventually implicate the total duration of circulatory arrest and the epochs of mean arterial pressure<25 mmHg on cardiopulmonary bypass as independent predictors of hyperlactatemia. 1 Despite the presumption of the authors that the contextual lactate overproduction is largely a consequence of compromised systemic oxygenation in this peculiarly predisposed cohort, a multifactorial etiological approach remains at the heart of a comprehensive hyperlactatemia evaluation.…”

“…1 The study meticulously employs regression models to eventually implicate the total duration of circulatory arrest and the epochs of mean arterial pressure<25 mmHg on cardiopulmonary bypass as independent predictors of hyperlactatemia. 1 Despite the presumption of the authors that the contextual lactate overproduction is largely a consequence of compromised systemic oxygenation in this peculiarly predisposed cohort, a multifactorial etiological approach remains at the heart of a comprehensive hyperlactatemia evaluation. 2 Appropriate to the aforementioned context, the blood glucose alterations should be addressed in close conjunction to the interpretation of the perioperative lactate dynamics.…”

“…Moreover, in the most practical sense of the matter, blood glucose monitoring is an important component of safe management of total circulatory arrest, particularly with the patients receiving glucocorticoids as in the Nasr et al sudy. 1,4 Adelsmayr et al highlight a significant impact of blood glucose levels and blood glucose variability on the subsequent lactate elevations in their retrospective analysis of 1,170 intensive care unit patients. 5 The association described in their study is supported by a multivariate regression analysis, adjusting for the severity of the involved illness.…”

“…6 The time intervals of glucose-lactate evaluation in the He et al study were similar to those used in the Nasr et al study. 1,6 Interestingly, Chen et al reveal an extended impact of the blood glucose levels on the inhospital mortality predictive value of serum lactate in critically ill surgical subset. 7 Chen et al describe that the serum lactate levels predicts mortality in the hypoglycemic (<7 mmol/L) and the hyperglycemic groups (>9 mmol/L) but not in the normoglycemic (7-9 mmol/L) study group.…”