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

Şahutoğlu, Cengiz; Yaşar, Ahmet; Kocabas, S.; Aşkar, Fatma Zekiye; Ayık, Mehmet Fatih; Atay, Yüksel

doi:10.5606/tgkdc.dergisi.2018.15791

Cited by 16 publications

(10 citation statements)

References 20 publications

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“…It is known that lactate and metabolic acidosis are important parameters that might indicate circulatory failure and tissue hypoxia. 23 , 24 Our study is the first one to examine the pH and lactate levels while examining patients for their hemodynamics. As understood from the results in Table 2 , the pH and lactate values in the carotid group were close to the normal physiological values and the difference between the 2 groups was statistically significant (lactate: 2.04 vs. 2.13 mmol/L, P = .007, pH: 7.33 vs. 7.26, P = .019).…”

Section: Discussionmentioning

confidence: 99%

A Better Way for Ductal Stenting in Patients with Duct-Dependent Pulmonary Flow and Vertical and Tortuous Patent Ductus Arteriosus

Aldudak¹,

Akdeniz²,

Duyorgan³

et al. 2022

The Anatolian Journal of Cardiology

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Background: In this study, we aimed to compare the femoral route and the carotid artery route in terms of procedural success of ductal stent implantation in patients with duct-dependent pulmonary blood flow. Methods: The study included 51 patients with duct-dependent pulmonary circulation who underwent ductal stent implantation upon their admission to our clinic between July 2017 and March 2021. In total, 23 patients (group I) underwent ductal stent implantation via the femoral route, while the remaining 28 (group II) underwent the procedure via the carotid artery. The groups were compared in terms of procedural success, time, post-procedural blood pH, lactate levels, and complications. Results: Duct morphology was observed in group 1 as follows: type 1 in 12 patients, type 3 in 8, type 2 in 2, and type 6 in 1 patient. In group 2, 26 patients had type 3, 1 had type 2, and 1 had type 6. The tortuosity index of the patients in group 1 was 1 in 8 patients, 2 in 8 patients, and 3 in 7 patients, while in group 2, it was 1 in 5 patients, 2 in 15 patients, and 3 in 8 patients. The success rate was 69.6% (16/26) in group I and 93.5% (29/31) in group II ( P = .030). The cumulative success rate was 88.2% (45/51). The procedural durations were 78.2 ± 34.1 and 52.1 ± 22.0 minutes in group I and group II, respectively ( P = .002). The mean blood pH values upon the completion of the procedure were 7.26 ± 0.1 and 7.33 ± 0.0 in group I and group II, respectively ( P = .038). The mean post-procedural lactate levels were 2.8 mmol/L and 2.3 mmol/L in group I and group II, respectively ( P = .038). The 2 groups did not show any differences in terms of procedural complications. Conclusion: The carotid artery route can be preferred, especially in vertical and tortuous ductus arteriosus, as it is associated with a high success rate and a short procedural time, as well as a better metabolic condition after the procedure.

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Section: Discussionmentioning

confidence: 99%

A Better Way for Ductal Stenting in Patients with Duct-Dependent Pulmonary Flow and Vertical and Tortuous Patent Ductus Arteriosus

Aldudak¹,

Akdeniz²,

Duyorgan³

et al. 2022

The Anatolian Journal of Cardiology

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“…28 Arterial blood lactate of ≥4.5 mmol/L was found to be a risk factor associated with postoperative morbidity and mortality in children who underwent CHD surgery in another study. 29 There is no study in literature examining the relationship between lactate levels and theophylline administration. We demonstrated lower lactate levels during and after cardiopulmonary bypass and a lower rate of lactate increase in patients who received theophylline, suggesting that theophylline may be protective in terms of mortality when evaluated together with the results of previous studies.…”

Section: Discussionmentioning

confidence: 99%

Effect of intraoperative theophylline use on acute kidney injury in paediatric cardiac surgery

Yavuz

Işıldak

2022

Cardiol Young

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Background: This study aimed to examine the effects of theophylline use in preventing renal dysfunction in patients undergoing CHD surgery. Methods: A total of 94 patients aged 1–60 months were included in the study. Patients in the theophylline group were enrolled according to a pre-defined protocol for treatment administration, while controls were selected retrospectively from patients without theophylline treatment during the same period – who were matched according to critical baseline characteristics. Results: The incidence of acute kidney injury was similar between the two groups (p = 1.000). Higher urinary output and lower fluid balance were found intraoperatively and also postoperatively in the theophylline group (all, p < 0.050). Postoperative decrease in urinary output and estimated glomerular filtration rate were higher in the theophylline group (p < 0.050). Lower postoperative urea and creatinine levels were shown in theophylline recipients (p < 0.050). Urea levels increased significantly in the non-theophylline group during surgery (p < 0.001), and no significant change was observed in theophylline group (p = 0.136). Postoperative increase in creatinine and lactate levels was demonstrated in theophylline group (p < 0.050), and lactate levels were higher in the non-theophylline group during and after cardiopulmonary bypass (p = 0.010). Multiple linear regression analysis revealed less reduction in estimated glomerular filtration rate with higher age and in the presence of theophylline use (p < 0.050). Conclusion: Although we demonstrated a similar incidence of acute kidney injury in the both groups, we revealed an important decrease in serum creatinine, urea and lactate levels, accompanied by improved estimated glomerular filtration rate, increased urine output and decreased fluid overload, with theophylline treatment, suggesting that renal functions significantly improved with the use of theophylline.

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“…Early signs of storage lesion are falling pH and rising potassium and lactate levels, 7 the latter being a well-accepted marker for poor outcome in neonates and infants undergoing early bypass surgery, being prone to suffer from low cardiac output syndrome (LCOS). 8 9 The ongoing glycolysis in the red cells produces adenosine 5′-triphosphate, leading to an increase in lactate and protons which in turn lowers the pH in pRBC. 10 Meanwhile, a gradually diminishing cation gradient caused by membrane loss due to erythrocytic vesiculation and dehydration accelerates a rise in extracellular potassium.…”

Section: Introductionmentioning

confidence: 99%

Risk Assessment of Red Cell Transfusion in Congenital Heart Disease

Zürn

Hohn

Hübner

et al. 2022

Thorac Cardiovasc Surg

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Background The storage time of packed red blood cells (pRBC) is an indicator of change in the product's pH, potassium, and lactate levels. Blood–gas analysis is a readily available bedside tool on every intensive care ward to measure these factors prior to application, thus facilitating a calculated decision on a transfusion's quantity and duration.Our first goal is to assess the impact of storage time on pH, potassium, and lactate levels in pRBC. The influence of those parameters in the transfused children will then be evaluated. Methods In this retrospective study, we conducted blood–gas analyses of pRBC units before they were administered over 4 hours to neonates, infants, and children in our pediatric cardiac intensive care ward. All patients underwent regular blood–gas analyses themselves, before and after transfusion. Results We observed a highly significant correlation between the storage time of pRBC units and a drop in pH, as well as an increase in potassium and lactate of stored red cells (p< 0.0001). Median age of recipients with a complete blood–gas dataset was 0.1 (interquartile range [IQR] = 0.0–0.7) years; median pRBC storage duration was 6 (IQR = 5–8) days. Further analyses showed no statistically significant effect on children's blood gases within 4 hours after transfusion, even after stratifying for pRBC storage time ≤7 days and >7 days. Conclusion Stored red blood cells show a rapid decrease in pH and increase in potassium and lactate. Slow transfusion of these units had no adverse effects on the recipients' pH, potassium, and lactate levels.

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

Cited by 16 publications

References 20 publications

A Better Way for Ductal Stenting in Patients with Duct-Dependent Pulmonary Flow and Vertical and Tortuous Patent Ductus Arteriosus

A Better Way for Ductal Stenting in Patients with Duct-Dependent Pulmonary Flow and Vertical and Tortuous Patent Ductus Arteriosus

Effect of intraoperative theophylline use on acute kidney injury in paediatric cardiac surgery

Risk Assessment of Red Cell Transfusion in Congenital Heart Disease

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