Goal-directed medical therapy and point-of-care testing improve outcomes after congenital heart surgery

Rossi, Anthony F.; Khan, Danyal; Hannan, Robert L.; Bolívar, Juan M.; Zaidenweber, Michel; Burke, Redmond P.

doi:10.1007/s00134-004-2504-1

Cited by 55 publications

(25 citation statements)

References 33 publications

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“…It may be used to prognosticate outcome or as an end point of resuscitation in critical illness [3][4][5][6][7] . In children recovering from congenital heart surgery, the degree of hyperlactatemia is directly related to mortality [5] .…”

Section: Discussionmentioning

confidence: 99%

Hyperlactatemia in Neonates Admitted to the Cardiac Intensive Care Unit with Critical Heart Disease

Rossi

Lopez²,

Dobrolet³

et al. 2010

Neonatology

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Neonates with critical heart disease are at risk of significant deficiencies in systemic oxygen delivery. The incidence and clinical pattern of hyperlactatemia in neonates presenting with critical heart disease has not been described. We reviewed the lactate pattern of neonates transferred to our cardiac intensive care unit for surgical management of their heart disease over a 1-year period. Stabilization of these neonates began in the referring institutions. From 8/4/03 to 8/4/04, 75 neonates with critical heart disease were transferred to our unit for stabilization and subsequent surgery. Blood lactate was measured on admission and subsequently in any patient thought to be at risk of low systemic oxygen delivery. Lactate was measured in 59 patients on admission and in 63 patients within the first 48 h of admission. Median age on admission was 1 day (range 0–13). Median age at surgery was 8 days (range 1–30). Median length of stay was 20 days. Peak lactate was noted on admission in 51 patients, and at 12–24 h in 8 patients. Mild hyperlactatemia (2.3–5 mmol/l) was present in 30 patients on admission and moderate-to-severe hyperlactatemia (≧5 mmol/l) was present in 8 patients. Mean lactate level on admission was 3.1 ± 0.6 mmol/l, and this did not return to normal (<2.3 mmol/l) until 36 h after admission. Severe hyperlactatemia patients also were noted to have normal lactate levels by 36 h. The presence of hyperlactatemia did not affect length of stay or mortality. There were no preoperative deaths and 4 postoperative deaths (1 death in 38 patients with mild or severe hyperlactatemia). Hyperlactatemia is frequently present in neonates admitted to a tertiary care center for management of congenital heart disease. Blood lactate levels normalize within 36 h. The presence of preoperative hyperlactatemia, even when moderate-to-severe, does not have significant adverse effect on postoperative mortality.

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Section: Discussionmentioning

confidence: 99%

Hyperlactatemia in Neonates Admitted to the Cardiac Intensive Care Unit with Critical Heart Disease

Rossi

Lopez²,

Dobrolet³

et al. 2010

Neonatology

Self Cite

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“…A study compared a prospective cohort of 710 postoperative cardiac patients with an historical cohort of 1656, following the introduction of a treatment protocol in which medial therapy was escalated if blood lactate levels were >5 mmol/L 40. A mortality difference was only identified in children under 1 year of age, most significantly for neonates (3.4% vs 12%, p=0.001).…”

Section: Indications and Limitationsmentioning

confidence: 99%

How to use lactate

Fine-Goulden

Durward

2013

Arch Dis Child Educ Pract Ed

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“…4 However, the role of lactate as a marker in goal-directed therapy is less clear. 2,4 However, lactate levels can be helpful when examined as a trend, and rising lactate levels should prompt further evaluation of the patient. 17 Similarly, lactate levels can also be elevated by seizures, shivering, large volume resuscitation of lactated ringers, liver dysfunction, acute lung injury, and exogenous catecholamine infusions.…”

Section: Lactatementioning

confidence: 99%

“…2 The use of goal-directed therapy is not unique to adult critical care. In an article published that year in the New England Journal of Medicine, Rivers et al 1 showed a significant reduction in the mortality of adult septic shock patients with early goal-directed therapy.…”

mentioning

confidence: 99%

Nursing Forum Editorial Board

&NA;

2008

Pediatric Emergency Care

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Goal-directed therapy has become the key to resuscitating critically ill patients since 2001. However, the ideal marker to guide pediatric resuscitation has remained elusive.The ideal marker is specific, sensitive, easy to use, safe, validated, and cost-effective. Lactate and base deficit are validated prognosticators, but both are affected by confounding conditions and resuscitative efforts. Mixed venous oximetry has been successfully used for guiding therapy but requires a pulmonary artery catheter for measurement. Central venous oximetry, on the other hand, can be more easily measured and is now the standard of care in goal-directed therapy for adult septic shock. Pediatric literature related to central venous oximetry is still in relative infancy, but seems promising. Sublingual capnometry may also prove to be useful, but no pediatric research has been published related to this device. Finally, near-infrared spectroscopy monitoring may be useful in highlighting changes in patient conditions, but its use in goal-directed therapy is limited by the wide interpatient variability. In summary, the search for the ideal marker of tissue perfusion continues, but there is promise on the horizon.

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Goal-directed medical therapy and point-of-care testing improve outcomes after congenital heart surgery

Abstract: The combination of goal-directed therapy and point-of-care testing was associated with a marked decrease in mortality for patients undergoing congenital heart surgery. Improvement was greatest in the highest risk patients.

Cited by 55 publications

References 33 publications

Hyperlactatemia in Neonates Admitted to the Cardiac Intensive Care Unit with Critical Heart Disease

Hyperlactatemia in Neonates Admitted to the Cardiac Intensive Care Unit with Critical Heart Disease

How to use lactate

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