Multisite Near-Infrared Spectroscopy Predicts Elevated Blood Lactate Level in Children After Cardiac Surgery

The Physiology and the Clinical Significance of Postoperative Hyperlactatemia After Pediatric Cardiac Surgery

“…The major causes of secondary hyperlactatemia are shock (cardiogenic, septic, hypovolemic), regional hypoperfusion (limb, mesenteric ischemia), severe hypoxemia, severe anemia, carbon monoxide poisoning, and severe respiratory acidosis (asthma) (Juneja et al, 2011;Mizock, 1989). The relationship between regional oxyhemoglobin saturation (rS0 2 ) and lactate is exponential in nature, as demonstrated in a study which aimed to determine whether there is a relationship between rS0 2 measured at various body locations by near-infrared spectroscopy and blood lactate level in children after cardiac surgery (Chakravarti et al, 2009). …”

“…Moreover the mean initial postoperative lactate level was significantly lower for survivors (42.2 ±32.0 mg/dL) than for nonsurvivors (85.4 ± 54.1 mg/dL) (p<0.01) (Molina Hazan et al, 2010). In another study in which 23 pediatric non-cyanotic patients were included, lactate was measured at 0, 2, 4, 6, and 24 hours after admission to the pediatric intensive care unit (PICU), and more often if clinically indicated (Chakravarti et al, 2009). A total of 163 lactate measurements were recorded, of which 18% had a value greater than 3 mmol/L (27 mg/dL).…”

“…Early postoperative measurable adverse effects, such as base deficit, maximal anion gap and bicarbonate levels, were significantly different between patients with postoperative hyperlactatemia and patients with low-normal lactatemia in the early postoperative period (i.e., less than 12 hours after admission to the ICU), while postoperative lactate and glucose levels were significantly correlated (Abraham et al, 2010;Chiolero et al, 2000). Inadequate tissue oxygen delivery because of impaired cardiac output after pediatric cardiac surgery is a relatively common problem which can be expressed in early stages by hyperlactatemia, and one that has been associated with significant morbidity and mortality (Chakravarti et al, 2009). Elevated lactate concentrations were associated with metabolic acidosis following cardiac surgery.…”

“…Most of these indicators do not reflect cardiovascular performance very well (Tibby et al, 1997). Averaged cerebral and renal rS0 2 levels of less than 65% as measured by near-infrared spectroscopy (NIRS) predict hyperlactatemia (>3 mmol/L, 27 mg/dL ) in acyanotic children after congenital heart surgery (Chakravarti et al, 2009). The averaged cerebral and renal rS0 2 was a good predictor of the lactate status, with a value less than or equal to 65%, predicting a lactate level of greater than or equal to 3.0 mmol/L (27 mg per dL), with a sensitivity of 95% and a specificity of 83% in the studied patients.…”

Monitoring technologies in the neonatal intensive care unit: implications for the detection of necrotizing enterocolitis

“…A multisite measurement may provide more accurate information about regional tissue perfusion. 45 The problem associated with low resolution may be resolved as the technology evolves. 46 Improved algorithms, such as time-resolved spectroscopy, allow calculation of the absolute values of oxygen saturation.…”