Hyperlactatemia after pediatric cardiac surgery

Abstract

The accurate identification of patients who have the potential to further deteriorate after cardiac surgery is difficult. Hyperlactataemia after cardiac surgery in children is associated with an increased risk of adverse outcome. The aim of this study was to investigate the effect of increased serum lactate on outcome in children after the cardiopulmonary bypass. Serum lactate level was measured in 152 children undergoing open heart surgery in a tertiary paediatric cardiac surgical unit and were collected at the time of admission to the paediatric intensive care unit, the following data were collected from the medical records. Lactate level was more than 2 mmol/l (group1) and less than or equal to 2 mmol/l (group2). Demographic characteristics and details of surgery were similar in both groups. Increased cross-clamp (62,8±12,0 vs 30,2±5,8 minutes, p<0,0001) and cardiopulmonary bypass times (89,8±13,6 vs 53,1±8,8 minutes, p<0,0001) were associated with a significant rise in postoperative lactate levels. The duration of ventilatory support (21,3±4,1 vs 14,3±2,4 hours, p=0,0017) and intensive care unit stay (3,9±1,0 vs 2,3±0,3 days, p=0,0007) was significantly increased in patients from groupe1. The incidence of multiple organ dysfunction syndrome was greater in group1 (20(28,2%) vs 7(8,6%), p=0,0016) patients. This study has demonstrated that elevated blood lactate level is associated with adverse outcome, and monitoring the blood lactate level during and after cardiac surgery is a valuable tool in identifying the patients who have the potential to develop postoperative complications.