Intraoperative lactate levels and postoperative complications of pediatric cardiac surgery

Alves, Rodrigo Leal; Silva, André Luiz Aragão e; Kraychete, Nadja; Campos, Guilherme Oliveira; Martins, Marcelo Sampaio; Módolo, Norma Sueli Pinheiro

doi:10.1111/j.1460-9592.2012.03823.x

Cited by 24 publications

(26 citation statements)

References 16 publications

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“…Similar observations were reported by other authors in the pediatric population in various scenarios, such as with head trauma 3,14 and cardiac surgery. 2,19 Another significant finding in our study was the association between hyperglycemia on admission to the ICU and an increased length of stay in the ICU and hospital. Hirshberg et al 8 assessed children who were hospitalized in the ICU for over 24 hours and also found an association between the occurrence of hyperglycemia (blood glucose ≥ 150 mg/dl) during hospitalization in the ICU and a longer hospital stay.…”

Section: Discussionmentioning

confidence: 63%

“…6,13,19 Most studies in the pediatric population showing an association between morbidity and hyperglycemia were conducted in children who were the victims of a traumatic brain injury, underwent cardiac surgery, or were critically ill patients in intensive care units (ICUs). 2,6,9,19 Little is known about this association in children with CNS tumors undergoing elective surgical procedures. Therefore, the aim of this study was to assess whether the occurrence of postoperative complications is associated with higher blood glucose levels in the intraoperative and early postoperative periods of elective neurosurgical resections of CNS tumors in pediatric patients.…”

mentioning

confidence: 99%

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Association of increased morbidity with the occurrence of hyperglycemia in the immediate postoperative period after elective pediatric neurosurgery

Filho¹,

Alves²,

Fernandes³

et al. 2016

PED

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OBJECTIVE The acute elevation of blood glucose in perioperative pediatric patients subjected to cardiac surgery and in victims of head trauma is associated with higher rates of postoperative complications. Data on the occurrence of hyperglycemia and its association with unfavorable outcomes among patients who have undergone elective neurosurgery are scarce in the literature. This study aimed to determine whether the occurrence of hyperglycemia during the perioperative period of elective neurosurgery for the resection of tumors of the CNS in children is associated with increased morbidity. METHODS This retrospective cohort analysis included 105 children up to 12 years of age who underwent elective neurosurgery for resection of supratentorial and infratentorial CNS tumors between January 2005 and December 2010 at the São Rafael Hospital, a tertiary care medical center in Salvador, Brazil. Demographic data and intraoperative and postoperative information were collected from the medical records. Differences in blood glucose levels during the perioperative period were evaluated with nonparametric tests. RESULTS The patients who developed postoperative complications exhibited higher blood glucose levels on admission to the intensive care unit (ICU) (162.0 ± 35.8 mg/dl vs 146.3 ± 43.3 mg/dl; p = 0.016) and peak blood glucose levels on postoperative Day 1 (171.9 ± 30.2 mg/dl vs 156.1 ± 43.2 mg/dl; p = 0.008). Multivariate analysis showed that peak blood glucose levels on postoperative Day 1 were independently associated with a higher odds ratio for postoperative complication (OR 1.05). The occurrence of hyperglycemia (>150 mg/dl) upon admission to the ICU was associated with longer ICU (p = 0.003) and hospital (p = 0.001) stays. CONCLUSIONS The occurrence of hyperglycemia during the postoperative period after elective pediatric neurosurgery for the resection of CNS tumors was associated with longer hospital and ICU stays. Postoperative complications were associated with higher blood glucose levels upon admission to the ICU and higher peak blood glucose on the first postoperative day.

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Section: Discussionmentioning

confidence: 63%

mentioning

confidence: 99%

Association of increased morbidity with the occurrence of hyperglycemia in the immediate postoperative period after elective pediatric neurosurgery

Filho¹,

Alves²,

Fernandes³

et al. 2016

PED

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“…The prognostic value of BNP (using log-transformed values) was assessed by investigating the capacity to ameliorate the prediction of outcome in two sets of Cox proportional hazards analyses: 1) A prediction model with traditional risk factors [23,24] including age, Aristotle score and BSA as continuous predictors; 2) a second risk prediction model was built, adding to the fi rst model two operative parameters, CPB time and arterial lactate values at the end of operative time, commonly used for the risk stratifi cation in pediatric cardiac surgery [28,29] . To test the prognostic value of BNP, pre-and post-operative BNP values were added to both models.…”

Section: Bnp Values Versus Clinical Outcomesmentioning

confidence: 99%

Prognostic role of BNP in children undergoing surgery for congenital heart disease: analysis of prediction models incorporating standard risk factors

Cantinotti

Giordano

Scalese

et al. 2015

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…Zastosowanie krążenia pozaustrojowego (ang. extracorporeal circulation -ECC) nasila zwiększanie stężenia glukozy [2,3]. Stan ten wynika z hormonalnej stymulacji (endogenne katecholaminy i glikokortykosteroidy) i jest efektem działania leków (presory, steroidoterapia) [4].…”

Section: Wstępunclassified

Intraoperative glycaemic control and the effectiveness of myocardial reperfusion – initial reports

Marcinkiewicz¹,

Ostrowski²,

Janowska³

et al. 2012

kitp

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Introduction: The proper reperfusion after CABG relies on many factors. Intraoperative hyperglycaemia is a state associated with a negative prognosis. The ischemic markers -creatine kinase (CK-MB) and troponin I (T hs ) -are the molecular indicators of the aorto-coronary by-pass procedure effectiveness. Aim of the study: The purpose of the study was to assess the influence of intraoperative insulin infusion on the myocardial reperfusion, without concerning the preoperative metabolic condition. Materials and methods: The study included 42 randomly chosen patients, operated on in the Cardiosurgical Clinic in Lodz in 2010-2011. There were patients with diabetes (19), non-diabetic patients (20) and those with impaired glucose tolerance (3). During the operation4-5 glycaemic measurements were conducted. The glycaemic level of 135 mg/dl (7.5 mmol/l) was the aim. After the surgery CK-MB and Ths were assessed. The analysis included glycaemia from the operative day, and ischaemic marker measurements from the operative day and the first postoperative day. It also involved the blood pressure, the kind and amount of used liquids and medicaments. Results: 52.38% (22) patients were grouped as normoglycaemic (glicaemia ≤ 135 mg/dl in all measurements or except one). In 23.81% (10) patients there was intraoperative insulin infusion applied. The comparison of the operative measurements of glycaemia and CK-MB from the operative and first postoperative day showed positive correlation. The highest levels were noted in the group with insulin infusion (mean 46.4 U/l). In all groups the glycaemic measurements were further increasing on the intensive care unit (ICU). In the case of troponin measurements there were also higher levels noted in the hyperglycaemic patients than in the normoglycaemic. FORUM MŁODYCH 490Adres do korespondencji: Anna Marcinkiewicz, Klinika Kardiochirurgii, Katedra Kardiologii i Kardiochirurgii, Uniwersytet Medyczny w Łodzi, ul. S. Sterlinga 1/3, 91-425 Łódź, tel./faks +48 633 15 58, e-mail annamar87@o2.pl StreszczenieWstęp: Prawidłowa reperfuzja mięśnia sercowego po zabiegu pomostowania aortalno-wieńcowego (ang. coronary artery bypass graft -CABG) zależy od wielu czynników. Śródoperacyjna hiperglikemia jest stanem o udowodnionym negatywnym znaczeniu rokowniczym. Wskaźnikiem efektywności zabiegu CABG na poziomie molekularnym są markery uszkodzenia miokardium: izoenzym MB kinazy kreatynowej (CK-MB) i troponina I (T hs ). Cel pracy: Ocena wpływu śródoperacyjnej kontroli glikemii bez uwzględnienia przedoperacyjnego statusu metabolicznego na reperfuzję mięśnia sercowego. Materiały i metody: Badanie uwzględniało 42 losowo wybranych pacjentów operowanych w Klinice Kardiochirurgii w latach 2010-2011. Byli to pacjenci chorzy na cukrzycę (n = 19), bez cukrzycy (n = 20) oraz z nietolerancją glukozy (n = 3). Śródoperacyjnie dokonywano 4-5 pomiarów glikemii. Starano się osiągnąć stężenie 135 mg/dl (7,5 mmol/l). Po zabiegu wykonywano pomiary CK-MB i T hs . Analiza uwzględniała glikemię z doby operacyjnej, pomiary ma...

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Intraoperative lactate levels and postoperative complications of pediatric cardiac surgery

Abstract: Elevated intraoperative arterial lactate levels are associated with a higher morbidity and mortality in low- and medium-risk procedures, with or without CPB, in pediatric cardiac surgery.

Cited by 24 publications

References 16 publications

Association of increased morbidity with the occurrence of hyperglycemia in the immediate postoperative period after elective pediatric neurosurgery

Association of increased morbidity with the occurrence of hyperglycemia in the immediate postoperative period after elective pediatric neurosurgery

Prognostic role of BNP in children undergoing surgery for congenital heart disease: analysis of prediction models incorporating standard risk factors

Intraoperative glycaemic control and the effectiveness of myocardial reperfusion – initial reports

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