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


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

Amit Varma, Naresh Agrawal, Jyotirmay Das

Keywords : Children, pediatric cardiac surgery, plasma lactate

Citation Information : Varma 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: 01-12-2018

Copyright Statement:  Copyright © 2012; The Author(s).


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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  1. Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: Heart rate as an early predictor of prognosis. Crit Care Med 1987;15:923-9.
  2. Blood pressure and arterial lactate level are early indicators of short-term survival in human septic shock. Intensive Care Med 1996;22:17-25.
  3. Early markers of major adverse events in children after cardiac operations. J Thorac Cardiovasc Surg 1997;114:1042-52.
  4. Serum lactate as a predictor of mortality after paediatric cardiac surgery. Arch Dis Child 1997;77:235-8.
  5. Initial post-operative serum lactate predicts outcome in children after open heart surgery. Crit Care Med 1995;23:A205.
  6. Serum lactates correlate with mortality after operations for complex congenital heart disease. Ann Thorac Surg 1997;64:735-8.
  7. Serum lactate predicts postoperative complications after pediatric cardiac surgery. Pediatr Res 1996;39:54A.
  8. Central venous oxygen saturation and blood lactate levels during cardiopulmonary bypass are associated with outcome after pediatric cardiac surgery. Crit Care 2010;14:R149.
  9. Postoperative lactate concentrations predict the outcome of infants aged 6 weeks or less after intracardiac surgery: A cohort follow-up to 18 months. J Thorac Cardiovasc Surg 2005;130:837-43.
  10. Changes in whole blood lactate levels during cardiopulmonary bypass for surgery for congenital cardiac disease: An early indicator of morbidity and mortality. J Thorac Cardiovasc Surg 2000;119:155-62.
  11. Patterns of lactate values after congenital heart surgery and timing of cardiopulmonary support. Ann Thorac Surg 2005;80:1468-73.
  12. Lactic acidosis in critical illness. Crit Care Med 1992;20:80-93.
  13. Lactate metabolism. Crit Care Med 1987;3:725-46.
  14. Influences on lactate levels in children early after cardiac surgery: Prime solution and age. Crit Care Resusc 2005;7:87-91.
  15. Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease. J Thorac Cardiovasc Surg 2000;120:73-80.
  16. Synergistic immunosuppression caused by high-dose methylprednisolone and cardiopulmonary bypass. Ann Thorac Surg 1997;63:129-37
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