Initial postoperative serum lactate levels predict survival in children after open heart surgery

Siegel, Louis; Dalton, Heidi J.; Hertzog, James H.; Hopkins, Richard A.; Hannan, Robert L.; Hauser, Gabriel J.

doi:10.1007/bf01709563

Cited by 101 publications

(36 citation statements)

References 21 publications

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“…Hyperlactaemia is strongly correlated with postoperative morbidity and mortality for patients undergoing complex open-heart surgery, especially children and infants [10,11]. The lactate is a marker of poor tissue perfusion and low cardiac output and can lead to metabolic acidosis.…”

Section: Introductionmentioning

confidence: 99%

Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease

Swindell

Barker

McGuirk

et al. 2007

European Journal of Cardio-Thoracic Surgery

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Objective: High concentrations of potassium and lactate in irradiated red cells transfused during cardiopulmonary bypass may have detrimental effects on infants and neonates undergoing cardiac surgery. The effects of receiving washed and unwashed irradiated red cells from the cardiopulmonary circuit on serum potassium and lactate concentrations were compared. Methods: The study population included neonates and infants undergoing heart surgery for complex congenital heart disease. A control group (n = 11) received unwashed irradiated red cells and the study group (n = 11) received irradiated red cells washed in a cell saver (Dideco Electa) using 900 ml of 0.9% saline prior to pump priming. Potassium and lactate concentrations were compared before, during and after bypass. Results: Washing irradiated red cells reduced donor blood [potassium] from > 20 to 0.8 AE 0.1 mmol/l, and [lactate] from 13.7 AE 0.5 to 5.0 AE 0.3 mmol/l ( p < 0.001). The resulting prime had significantly lower [potassium] and [lactate] than the unwashed group (potassium 2.6 AE 0.1 vs 8.1 AE 0.4 mmol/l, p < 0.001; lactate 2.6 AE 0.2 vs 4.6 AE 0.3 mmol/l, p < 0.001). Peak [potassium] in the unwashed group occurred 3 minutes after going on bypass (4.9 AE 0.3 mmol/l) and during rewarming (4.9 AE 0.4 mmol/l). These were significantly higher than the washed group (3.1 AE 0.1, p < 0.001 and 3.0 AE 0.1 mmol/l, p < 0.001). The [potassium] was greater than 6.0 mmol/l for 4 out of these 11 unwashed patients compared with none of the washed group. Immediately postbypass the washed group had significantly lower serum [potassium] (3.2 AE 0.1 vs 4.2 AE 0.2 mmol/l, p = 0.002). There was no significant difference in [lactate] between groups during and after cardiopulmonary bypass. Conclusions: The washing of irradiated red cells reduces potassium and lactate loads and prevents hyperkalaemia during cardiopulmonary bypass. The washing of irradiated red cells should be considered in neonates and infants undergoing cardiac surgery for complex congenital heart disease. #

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Section: Introductionmentioning

confidence: 99%

Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease

Swindell

Barker

McGuirk

et al. 2007

European Journal of Cardio-Thoracic Surgery

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“…1 Siegel et al observed that, in children admitted to the ICU after a cardiac surgery, high levels of lactate had a positive predictive value of 100% and a negative predictive value of 97% for death. 28 By using univariate logistic regression, Duke et al found that lactate allowed distinguishing survivors from nonsurvivors among children with sepsis at 12 and 24 hours of admission. 29 Hatherill et al suggest that hyperlactatemia can indicate death on admission and if it persists after 24 hours of treatment.…”

Section: Discussionmentioning

confidence: 99%

Lactato sérico como marcador prognóstico em crianças gravemente doentes

Koliski¹,

Cat²,

J³

et al. 2005

J. Pediatr. (Rio J.)

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Objective: To assess the use of lactate as a marker of tissue hypoperfusion and as a prognostic index in critically ill patients.Methods: Prospective, longitudinal, observational study of 75 patients admitted to the pediatric ICU of Hospital de Clínicas of Universidade Federal do Paraná, between November 1998 and May 1999. According to the lactate level on admission, patients were divided into group A (lactate > 18 mg/dl) and group B (lactate < 18 mg/dl). In terms of outcome, patients were classified into survivors and nonsurvivors. In group A, the clinical evaluation and the collection of arterial blood samples were performed on admission, at 6, 12, 24, 48 hours, and every 24 hours after that. In group B, they were carried out in the same way, but interrupted 48 hours after admission.Results: Groups A and B consisted of 50 and 25 patients, respectively. Group A presented more clinical signs of hypoperfusion (24/50). There was a statistically significant difference regarding the mean lactate levels on admission between those patients who died within 24 hours of admission (95 mg/dl) and those who died 24 hours after admission (28 mg/dl). The lactate level at 24 hours of admission revealed better sensitivity (55.6%) and specificity (97.2%) as a predictor of death.Conclusions: Most patients with lactate levels > 18 mg/dl showed clinical signs of hypoperfusion on admission. The normalization or reduction of lactate levels at and after 24 hours of admission was significantly related with higher chances of survival.J Pediatr (Rio J). 2005;81(4):287-92: Blood lactate, lactic acidosis, hyperlactatemia, prognostic index, PICU mortality.

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“…Several studies [58][59][60][61] examined the prognostic value of blood lactate after congenital heart operations and they have found conflicting results, but agreed in the power of its serial determination 62 . Rossi and coworkers 62 postulate that elevated lactate levels might represent previous hemodynamic compromise, during or before operation, sometimes associated with liver dysfunction.…”

Section: Hemodynamic Assessment In Hlhsmentioning

confidence: 99%

Fisiologia aplicada ao tratamento atual do recém-nascido com síndrome de hipoplasia do coração esquerdo

Atik¹

2006

Arq. Bras. Cardiol.

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Initial postoperative serum lactate levels predict survival in children after open heart surgery

Cited by 101 publications

References 21 publications

Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease

Washing of irradiated red blood cells prevents hyperkalaemia during cardiopulmonary bypass in neonates and infants undergoing surgery for complex congenital heart disease

Lactato sérico como marcador prognóstico em crianças gravemente doentes

Fisiologia aplicada ao tratamento atual do recém-nascido com síndrome de hipoplasia do coração esquerdo

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