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VOLUME 16 , ISSUE 4 ( October, 2012 ) > List of Articles

ORIGINAL ARTICLE

Point of care serum lactate levels as a prognostic marker of outcome in complex pediatric cardiac surgery patients: Can we utilize it?

Amit Varma, Amit Agrawal, Naresh Agrawal, Jyotirmay Das

Keywords : Children, pediatric cardiac surgery, plasma lactate

Citation Information : Varma A, Agrawal A, Agrawal N, Das J. Point of care serum lactate levels as a prognostic marker of outcome in complex pediatric cardiac surgery patients: Can we utilize it?. Indian J Crit Care Med 2012; 16 (4):193-197.

DOI: 10.4103/0972-5229.106500

License: CC BY-ND 3.0

Published Online: 01-10-2012

Copyright Statement:  Copyright © 2012; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Post-operative course after complex pediatric cardiac surgery is unpredictable. Although, change in arterial lactate levels has been used as a surrogate marker for many years, scientific evidence correlating the early perioperative lactate levels with outcome is still lacking. Objective: To evaluate the trends in lactate levels from intraoperative period to an extended post-operative period in pediatric intensive care unit (PICU) and to assess its usefulness as a prognostic marker. Design: Prospective observational study. Setting: Tertiary pediatric cardiac surgical unit. Patients: Thirty-five non-consecutive children aged 1-140 months who underwent surgery for congenital heart diseases (CHD) on cardiopulmonary bypass (CPB). Intervention: None. Materials and Methods: Arterial blood lactate levels were obtained at the following time points: After induction of anesthesia, 15 and 45 min after institution of CPB, at the start of rewarming, after sternotomy closure, then at 1, 6, 24, and 48 h in PICU. Other hemodynamic and clinical variables, CPB variables, blood gas values, and laboratory variables were also recorded. Results: Four patients died out of 35 patients (11.4%). Non-survivors showed significant persistent elevation in lactates (>4.0 mmol/l). Peak lactates correlate significantly with longer aortic cross clamp time, CPB duration, ventilation hours and PICU stay. Conclusion: Early point of care lactate can be a useful prognostic marker in post-cardiac surgery patients in adjunct with other parameters measured in PICU. This reiterates the importance of measuring lactates and timely recognition of at-risk patients, which on early intervention can help in reducing post-operative morbidity and mortality.


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