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Korkut DG, Özlü F, Atlı G, Yıldız ŞM, Demir F, Göçen U, Yapıcıoğlu H. Ischemic-Modified Albumin in Neonates with Congenital Heart Defects. Am J Perinatol 2024; 41:e827-e832. [PMID: 36584690 DOI: 10.1055/s-0042-1758488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Ischemia-modified albumin (IMA) is a new biochemical marker of ischemia. We aimed to search blood IMA levels in neonates with congenital heart defects. STUDY DESIGN During the study period, patients diagnosed with congenital heart disease and newborns with a diagnosis of hyperbilirubinemia as a control group were included in the study. IMA level was analyzed using the IMA absorbance unit (ABSU) method. RESULTS In total, 57 newborns with congenital heart disease requiring cardiac operation for the study group and 38 newborns for the control group were included. There was no difference between the two groups in terms of gender, mode of delivery, and weeks of gestation. The average IMA values in the control group were 0.19 ± 0.09 ABSU. The prepostoperative mean IMA values of the patient group were 0.22 ± 0.07 and 0.23 ± 0.07 ABSU, respectively. Comparison of the postoperative IMA with the mean of the control group was statistically significant. Preoperative and postoperative IMA values of patients who have died due to primary heart disease and surgical complications were 0.21 ± 0.07 (0.08-0.32) ABSU and 0.25 ± 0.06 (0.12-0.36) ABSU, respectively. IMA levels were not statistically different between the two groups. CONCLUSION Hypoxia and ischemia in congenital heart disease in the newborn period both preoperatively and postoperatively were important in prognosis. IMA was higher in the postoperative group. Many comprehensive studies are important in terms of preventing complications and decreasing mortality and morbidity by commenting on prognosis. KEY POINTS · IMA is a new biochemical marker of ischemia.. · In the literature, there are no reports about the relation between congenital heart defects and IM.. · The exposure of CHD patients to hypoxia/asphyxia in the preintra and postoperative periods cause neurologic deficits.
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Affiliation(s)
- Didem G Korkut
- Departemnt of Pediatrics, Çukurova University Medical Faculty, Adana, Turkey
| | - Ferda Özlü
- Department of Neonatology, Çukurova University Medical Faculty, Adana, Turkey
| | - Gülizar Atlı
- Department of Biotechnology Centre, Çukurova University Medical Faculty, Adana, Turkey
| | - Şule M Yıldız
- Department of Biotechnology Centre, Çukurova University Medical Faculty, Adana, Turkey
| | - Fadli Demir
- Department of Pediatric Cardiology, Çukurova University Medical Faculty, Adana, Turkey
| | - Uğur Göçen
- Department of Cardiovascular Surgery, Çukurova University Medical Faculty, Adana, Turkey
| | - Hacer Yapıcıoğlu
- Department of Neonatology, Çukurova University Medical Faculty, Adana, Turkey
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Kumar A, Kapoor R, Mishra S, Joshi A, Tiwari N, Ramamurthy H. Non-analgesic benefits of combined thoracic epidural analgesia with general anesthesia in on-pump pediatric cardiac surgery: A prospective observational study. Med J Armed Forces India 2024; 80:80-90. [PMID: 38261822 PMCID: PMC10793232 DOI: 10.1016/j.mjafi.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/20/2023] [Indexed: 01/25/2024] Open
Abstract
Background The use of thoracic epidural analgesia in infants and children could attenuate the stress response and thereby improve the outcomes associated with cardiac surgery. Methods This study is a prospective observational study conducted on 118 patients admitted for cardiac surgery. All patients received thoracic epidural analgesia. Laboratory investigations including inflammatory markers, markers for different organ functions, and intensive care unit parameters were collected at different time points (preoperative, immediate postoperative, on day 1, and day 2). Results Inflammatory markers such as IL6, IL8, and metabolic response as measured by serum cortisol and blood sugar were significantly high in the immediate postoperative period, which later stabilized in the next 48 h. There was also a sharp increase in the anti-inflammatory marker IL-10 in an immediate postoperative period, which settled later on but continued to be higher than baseline in the next 48 h. All these markers showed lower values when compared to published literature. The baseline renal oxygen saturation using near infrared spectroscopy (NIRS) value in our study was 59.3 + 19, which increased to 76.4 + 12.7 on day 2. Serum neutrophil gelatinase associated lipocalin (NGAL) remained well below normal levels in the perioperative period. PF (pO2/FiO2) ratio and pO2 consistently improved postoperatively with the maximum on day 2. The median mechanical ventilation (MV) duration was 18 h, and the mean length of stay that included intensive care unit stay was 12 days. No epidural-related adverse events were noted. Conclusions Apart from good analgesia, patients receiving thoracic epidural analgesia displayed a reduction in perioperative stress, superior postoperative glycemic control, reduction in inflammatory markers, postoperative acute kidney injury, and pulmonary complications.
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Affiliation(s)
- Alok Kumar
- Senior Advisor (Anesthesia & Cardiothoracic Anaesthesia), Army Hospital (Research & Referral), New Delhi, India
| | - Ravi Kapoor
- Classified Specialist (Biochemistry), Army Hospital (Research & Referral), New Delhi, India
| | - Shubham Mishra
- Resident (Anaesthesia), Army Hospital (Research & Referral), New Delhi, India
| | - Ankur Joshi
- Classified Specialist (Anaesthesia & Cardiothoracic Anaesthesia), Army Hospital (Research & Referral), New Delhi, India
| | - Nikhil Tiwari
- Consultant (Surgery) & Cardiothoracic Surgeon, Army Institute of Cardiothoracic Sciences, Pune, India
| | - H.R. Ramamurthy
- Senior Advisor (Paediatrics) & Trained in Paediatric Cardiology, Army Hospital (Research & Referral), New Delhi, India
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Asfari A, Wolovits J, Gazit AZ, Abbas Q, Macfadyen AJ, Cooper DS, Futterman C, Penk JS, Kelly RB, Salvin JW, Borasino S, Zaccagni HJ. A Near Real-Time Risk Analytics Algorithm Predicts Elevated Lactate Levels in Pediatric Cardiac Critical Care Patients. Crit Care Explor 2023; 5:e1013. [PMID: 38053749 PMCID: PMC10695536 DOI: 10.1097/cce.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Postoperative pediatric congenital heart patients are predisposed to develop low-cardiac output syndrome. Serum lactate (lactic acid [LA]) is a well-defined marker of inadequate systemic oxygen delivery. OBJECTIVES We hypothesized that a near real-time risk index calculated by a noninvasive predictive analytics algorithm predicts elevated LA in pediatric patients admitted to a cardiac ICU (CICU). DERIVATION COHORT Ten tertiary CICUs in the United States and Pakistan. VALIDATION COHORT Retrospective observational study performed to validate a hyperlactatemia (HLA) index using T3 platform data (Etiometry, Boston, MA) from pediatric patients less than or equal to 12 years of age admitted to CICU (n = 3,496) from January 1, 2018, to December 31, 2020. Patients lacking required data for module or LA measurements were excluded. PREDICTION MODEL Physiologic algorithm used to calculate an HLA index that incorporates physiologic data from patients in a CICU. The algorithm uses Bayes' theorem to interpret newly acquired data in a near real-time manner given its own previous assessment of the physiologic state of the patient. RESULTS A total of 58,168 LA measurements were obtained from 3,496 patients included in a validation dataset. HLA was defined as LA level greater than 4 mmol/L. Using receiver operating characteristic analysis and a complete dataset, the HLA index predicted HLA with high sensitivity and specificity (area under the curve 0.95). As the index value increased, the likelihood of having higher LA increased (p < 0.01). In the validation dataset, the relative risk of having LA greater than 4 mmol/L when the HLA index is less than 1 is 0.07 (95% CI: 0.06-0.08), and the relative risk of having LA less than 4 mmol/L when the HLA index greater than 99 is 0.13 (95% CI, 0.12-0.14). CONCLUSIONS These results validate the capacity of the HLA index. This novel index can provide a noninvasive prediction of elevated LA. The HLA index showed strong positive association with elevated LA levels, potentially providing bedside clinicians with an early, noninvasive warning of impaired cardiac output and oxygen delivery. Prospective studies are required to analyze the effect of this index on clinical decision-making and outcomes in pediatric population.
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Affiliation(s)
- Ahmed Asfari
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Joshua Wolovits
- Division of Critical Care, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX
| | - Avihu Z Gazit
- Divisions of Critical Care and Cardiology, Department of Pediatrics, Washington University, St. Louis, MO
| | - Qalab Abbas
- Department of Pediatrics and Child Health, Section of Pediatric Critical Care Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Andrew J Macfadyen
- Division of Critical Care, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE
| | - David S Cooper
- Division of Cardiology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Craig Futterman
- Division of Critical Care, Department of Pediatrics, George Washington University, Washington, DC
| | - Jamie S Penk
- Division of Cardiology, Department of Pediatrics, Northwestern University, Chicago, IL
| | - Robert B Kelly
- Division of Critical Care, Children's Hospital of Orange County, Orange, CA
- Department of Pediatrics, University of California, Irvine, School of Medicine, Irvine, CA
| | - Joshua W Salvin
- Division of Cardiology, Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Santiago Borasino
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Hayden J Zaccagni
- Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
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Li JT, Zeng N, Yan ZP, Liao T, Chen X, Ni GX. Nuclear magnetic resonance-based metabolomic study of rat serum after anterior cruciate ligament injury. Sci Rep 2023; 13:19321. [PMID: 37935794 PMCID: PMC10630467 DOI: 10.1038/s41598-023-46540-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/02/2023] [Indexed: 11/09/2023] Open
Abstract
Anterior cruciate ligament (ACL) injury, a common sports injury, is associated with a high risk of subsequent osteoarthritis (OA), which can cause serious pain and disability. Understanding the detailed mechanism underlying the predisposition of knee with ACL injury to secondary OA at an early stage is key to preventing future degradation and progression to a clinically significant disease. A total of 56 male Sprague Dawley rats (age, 8 weeks; weight, 180-220 g) were randomly divided into three experimental groups: control, ACL transection (ACLT; where surgical procedure was performed with ACLT), and sham (where surgical procedure was performed without ACLT). The ACLT and sham groups were further divided into three subgroups based on when the rats were sacrificed: 4, 8, and 12 weeks after the surgical procedure. The control group and the aforementioned subgroups contained 8 rats each. We used nuclear magnetic resonance (NMR)-based metabolomic analysis to analyze rat serum samples for the metabolic characteristics and the underlying mechanisms. In total, 28 metabolites were identified in the NMR spectra of the rat sera. At 4 and 8 weeks postoperatively, the sham group demonstrated metabolic profiles different from those of the ACLT group. However, this difference was not observed 12 weeks postoperatively. In total, five metabolites (acetate, succinate, sn-glycero-3-phosphocholine, glucose, and phenylalanine) and five metabolic pathways (phenylalanine, tyrosine, and tryptophan biosynthesis; phenylalanine metabolism; pyruvate metabolism; starch and sucrose metabolism; and histidine metabolism) demonstrated significant differences between the ACLT and sham groups. ACL injury was noted to considerably affect biochemical homeostasis and metabolism; however, these metabolic changes persisted briefly. Moreover, glucose was a characteristic metabolite, and several energy-related metabolic pathways were significantly disturbed. Therefore, an ACL injury may lead to considerable impairments in energy metabolism. Abnormal glucose levels facilitate chondrocyte function impairment and thereby lead to OA progression. Furthermore, lactate may aid in identifying metabolic changes specific to knee trauma not related to an ACL injury. Overall, the metabolic changes in rat serum after an ACL injury were closely related to disturbances in energy metabolism and amino acid metabolism. The current results may aid in understanding the pathogenesis of posttraumatic osteoarthritis.
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Affiliation(s)
- Jie-Ting Li
- Department of Rehabilitation Medicine, Fuzhou Second Hospital, Fuzhou, China
| | - Ni Zeng
- Department of Rehabilitation Medicine, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Zhi-Peng Yan
- Department of Rehabilitation Medicine, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Tao Liao
- Department of Rehabilitation Medicine, Chengdu Second People's Hospital, Chengdu, China
| | - Xin Chen
- Department of Rehabilitation Medicine, Fuzhou Second Hospital, Fuzhou, China
| | - Guo-Xin Ni
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Xiamen University, Xiamen, China.
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Loomba RS, Dyamenahalli U, Savorgnan F, Acosta S, Elhoff JJ, Farias JS, Villarreal E, Flores S. The effect of clinical and haemodynamic variables on post-operative length of stay immediately upon admission after biventricular repair with Yasui operation following an earlier Norwood operation. Cardiol Young 2023; 33:2066-2071. [PMID: 36537282 DOI: 10.1017/s1047951122003948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND There are a variety of approaches to biventricular repair in neonates and infants with adequately sized ventricles and left-sided obstruction in the presence of a ventricular septal defect. Those who undergo this in a staged manner initially undergo a Norwood procedure followed by a ventricular septal defect closure such that the neo-aorta is entirely committed to the left ventricle and placement of a right ventricular to pulmonary artery conduit (Yasui operation). This study aimed to determine clinical and haemodynamic factors upon paediatric cardiac ICU admission immediately after the two-stage Yasui operation that was associated with post-operative length of stay. METHODS This was a retrospective review of patients who underwent the Yasui procedure after the initial Norwood operation between 1 January 2011 and 31 December 2020. Patients with complete data on admission were identified and analysed using Bayesian regression analysis. RESULTS A total of 15 patients were included. The median age was 9.0 months and post-operative length of stay was 6days. Bayesian regression analysis demonstrated that age, weight, heart rate, mean arterial blood pressure, central venous pressure, pulse oximetry, cerebral near infrared spectroscopy, renal near infrared spectroscopy, pH, pCO2, ionised calcium, and serum lactate were all associated with post-operative length of stay. CONCLUSION Discrete clinical and haemodynamic factors upon paediatric cardiac ICU admission after staged Yasui completion are associated with post-operative length of stay. Clinical target ranges can be developed and seem consistent with the notion that greater systemic oxygen delivery is associated with lower post-operative length of stay.
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Affiliation(s)
- Rohit S Loomba
- Division of Pediatric Cardiac Critical Care, Advocate Children's Hospital, Oak Lawn, IL, USA
- Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Umesh Dyamenahalli
- Division of Pediatric Cardiology, University of Chicago School of Medicine, Chicago, IL, USA
| | - Fabio Savorgnan
- Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sebastian Acosta
- Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Justin J Elhoff
- Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Juan S Farias
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Enrique Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Saul Flores
- Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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Kobayashi K, Higgins T, Liu C, Ayodeji M, Wernovsky G, Jonas RA, Ishibashi N. Defining the optimal historical control group for a phase 1 trial of mesenchymal stromal cell delivery through cardiopulmonary bypass in neonates and infants. Cardiol Young 2023; 33:1523-1528. [PMID: 35989537 PMCID: PMC9995118 DOI: 10.1017/s1047951122002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Mesenchymal Stromal Cell Delivery through Cardiopulmonary Bypass in Pediatric Cardiac Surgery study is a prospective, open-label, single-centre, dose-escalation phase 1 trial assessing the safety/feasibility of delivering mesenchymal stromal cells to neonates/infants during cardiac surgery. Outcomes will be compared with historical data from a similar population. We aim to define an optimal control group for use in the Mesenchymal Stromal Cell Delivery through Cardiopulmonary Bypass in Pediatric Cardiac Surgery trial. METHODS Consecutive patients who underwent a two-ventricle repair without aortic arch reconstruction within the first 6 months of life between 2015 and 2020 were studied using the same inclusion/exclusion criteria as the Phase 1 Mesenchymal Stromal Cell Delivery through Cardiopulmonary Bypass in Pediatric Cardiac Surgery trial (n = 169). Patients were allocated into one of three diagnostic groups: ventricular septal defect type, Tetralogy of Fallot type, and transposition of the great arteries type. To determine era effect, patients were analysed in two groups: Group A (2015-2017) and B (2018-2020). In addition to biological markers, three post-operative scoring methods (inotropic and vasoactive-inotropic scores and the Pediatric Risk of Mortality-III) were assessed. RESULTS All values for three scoring systems were consistent with complexity of cardiac anomalies. Max inotropic and vasoactive-inotropic scores demonstrated significant differences between all diagnosis groups, confirming high sensitivity. Despite no differences in surgical factors between era groups, we observed lower inotropic and vasoactive-inotropic scores in group B, consistent with improved post-operative course in recent years at our centre. CONCLUSIONS Our studies confirm max inotropic and vasoactive-inotropic scores as important quantitative measures after neonatal/infant cardiac surgery. Clinical outcomes should be compared within diagnostic groupings. The optimal control group should include only patients from a recent era. This initial study will help to determine the sample size of future efficacy/effectiveness studies.
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Affiliation(s)
- Kei Kobayashi
- Center for Neuroscience Research and Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC, USA
| | - Tessa Higgins
- Center for Neuroscience Research and Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Christopher Liu
- Center for Neuroscience Research and Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Mobolanle Ayodeji
- Center for Neuroscience Research and Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
| | - Gil Wernovsky
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Richard A. Jonas
- Center for Neuroscience Research and Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Nobuyuki Ishibashi
- Center for Neuroscience Research and Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Hospital, Washington, DC, USA
- Children’s National Heart Institute, Children’s National Hospital, Washington, DC, USA
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Morisson L, Duceau B, Do Rego H, Lancelot A, Hariri G, Charfeddine A, Laferrière-Langlois P, Richebé P, Lebreton G, Provenchère S, Bouglé A. A new machine learning algorithm to predict veno-arterial ECMO implantation after post-cardiotomy low cardiac output syndrome. Anaesth Crit Care Pain Med 2023; 42:101172. [PMID: 36375781 DOI: 10.1016/j.accpm.2022.101172] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Post-cardiotomy low cardiac output syndrome (PC-LCOS) is a life-threatening complication after cardiac surgery involving a cardiopulmonary bypass (CPB). Mechanical circulatory support with veno-arterial membrane oxygenation (VA-ECMO) may be necessary in the case of refractory shock. The objective of the study was to develop a machine-learning algorithm to predict the need for VA-ECMO implantation in patients with PC-LCOS. PATIENTS AND METHODS Patients were included in the study with moderate to severe PC-LCOS (defined by a vasoactive inotropic score (VIS) > 10 with clinical or biological markers of impaired organ perfusion or need for mechanical circulatory support after cardiac surgery) from two university hospitals in Paris, France. The Deep Super Learner, an ensemble machine learning algorithm, was trained to predict VA-ECMO implantation using features readily available at the end of a CPB. Feature importance was estimated using Shapley values. RESULTS Between January 2016 and December 2019, 285 patients were included in the development dataset and 190 patients in the external validation dataset. The primary outcome, the need for VA-ECMO implantation, occurred respectively, in 16% (n = 46) and 10% (n = 19) in the development and the external validation datasets. The Deep Super Learner algorithm achieved a 0.863 (0.793-0.928) ROC AUC to predict the primary outcome in the external validation dataset. The most important features were the first postoperative arterial lactate value, intraoperative VIS, the absence of angiotensin-converting enzyme treatment, body mass index, and EuroSCORE II. CONCLUSIONS We developed an explainable ensemble machine learning algorithm that could help clinicians predict the risk of deterioration and the need for VA-ECMO implantation in moderate to severe PC-LCOS patients.
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Affiliation(s)
- Louis Morisson
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM.
| | - Baptiste Duceau
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
| | - Hermann Do Rego
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
| | - Aymeric Lancelot
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
| | - Geoffroy Hariri
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
| | - Ahmed Charfeddine
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
| | - Pascal Laferrière-Langlois
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de L'Ile de Montréal, Montréal, Québec, Canada; Department of Anesthesiology and Pain Medicine, University of Montreal, Montréal, Québec, Canada
| | - Philippe Richebé
- Department of Anesthesiology and Pain Medicine, Maisonneuve-Rosemont Hospital, CIUSSS de l'Est de L'Ile de Montréal, Montréal, Québec, Canada; Department of Anesthesiology and Pain Medicine, University of Montreal, Montréal, Québec, Canada
| | - Guillaume Lebreton
- Department of Cardiac and Thoracic Surgery, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
| | - Sophie Provenchère
- Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard University Hospital, Paris, France
| | - Adrien Bouglé
- Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hospital, Paris, France. Sorbonne University, GRC 29, AP-HP, DMU DREAM
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Abhay P, Sharma R, Bhan A, Raina M, Vadhera A, Akole R, Mir FA, Bajpai P, Misri A, Srivastava S, Prakash V, Mondal T, Soundararajan A, Tibrewal A, Bansal SB, Sethi SK. Vasoactive-ventilation-renal score and outcomes in infants and children after cardiac surgery. Front Pediatr 2023; 11:1086626. [PMID: 36891234 PMCID: PMC9986414 DOI: 10.3389/fped.2023.1086626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/27/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction There is a need to index important clinical characteristics in pediatric cardiac surgery that can be obtained early in the postoperative period and accurately predict postoperative outcomes. Methodology A prospective cohort study was conducted in the pediatric cardiac ICU and ward on all children aged <18 years undergoing cardiac surgery for congenital heart disease from September 2018 to October 2020. The vasoactive-ventilation-renal (VVR) score was analyzed to predict outcomes of cardiac surgeries with a comparison of postoperative variables. Results A total of 199 children underwent cardiac surgery during the study period. The median (interquartile range) age was 2 (0.8-5) years, and the median weight was 9.3 (6-16) kg. The most common diagnoses were ventricular septal defect (46.2%) and tetralogy of Fallot (37.2%). At the 48th h, area under the curve (AUC) (95% CI) values were higher for the VVR score than those for other clinical scores measured. Similarly, at the 48th h, AUC (95% CI) values were higher for the VVR score than those for the other clinical scores measured for the length of stay and mechanical ventilation. Discussion The VVR score at 48 h postoperation was found to best correlate with prolonged pediatric intensive care unit (PICU) stay, length of hospitalization, and ventilation duration, with the greatest AUC-receiver operating characteristic (0.715, 0.723, and 0.843, respectively). The 48-h VVR score correlates well with prolonged ICU, hospital stay, and ventilation.
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Affiliation(s)
- Pota Abhay
- Pediatric Cardiology, Medanta, The Medicity Hospital, Gurgaon, India
| | - Rajesh Sharma
- Pediatric Cardiac Intensive Care, Medanta-The Medicity, Gurgaon, India
| | - Anil Bhan
- CTVS, Medanta-The Medicity, Gurgaon, India
| | - Manan Raina
- Hawken High School, Cleveland, OH, United States
| | | | - Romel Akole
- Pediatric Cardiac Intensive Care, Medanta-The Medicity, Gurgaon, India
| | | | - Pankaj Bajpai
- Pediatric Cardiology, Medanta, The Medicity Hospital, Gurgaon, India
| | - Amit Misri
- Pediatric Cardiology, Medanta, The Medicity Hospital, Gurgaon, India
| | | | | | - Tanmoy Mondal
- Pediatric Cardiac Intensive Care, Medanta-The Medicity, Gurgaon, India
| | - Anvitha Soundararajan
- Akron Nephrology Associates, Akron General Cleveland Clinic, Akron, OH, United States
| | - Abhishek Tibrewal
- Pediatric Nephrology, Akron's Children Hospital, Akron, OH, United States
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Does severe hyperlactatemia during cardiopulmonary bypass predict a worse outcome? Ann Med Surg (Lond) 2022; 73:103198. [PMID: 35070281 PMCID: PMC8767239 DOI: 10.1016/j.amsu.2021.103198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/14/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The aim of the current study was to evaluate the impact of increased blood lactate levels during cardiopulmonary bypass (CPB) on immediate results in patients who underwent open heart surgery. MATERIALS AND METHODS We performed a retrospective single-center study on 1290 patients. Adult cardiac surgical patients who underwent valve surgery, coronary artery bypass graft, combined procedure, adult congenital anomalies and aortic surgery were enrolled. Patients with associated comorbidities such as liver dysfunction, hemodynamic instability before surgery were excluded. Arterial blood lactate concentration was measured immediately after weaning from CPB and evaluated together with clinical data and outcomes including in hospital mortality. Patients were classified into 3 groups according to their peak arterial lactate level: group I [normal lactatemia, lactate ˂ 2 mmol/l (n = 749)], group II [mild hyperlactatemia, lactate 2-5 mmol/l (n = 489)], group III [severe hyperlactatemia, lactate ˃ 5 mmol/l (n = 52)]. RESULTS When comparing outcomes across the 3 groups, severe hyperlactatemia was correlated with worse outcomes including higher in-hospital mortality, low output cardiac syndrome, postoperative renal insufficiency, myocardial infarction, red blood cell transfusion (RBC) transfusion, prolonged mechanical ventilation and longer intensive care unit (ICU) stay hours. CONCLUSION Blood lactate level above 5 mmol/l and more during CPB is associated with higher in-hospital mortality rate and postoperative complications. More attention must be given to correct the common abnormalities conditions inherent of CPB in order to conduct adequate tissue perfusion and reduce the risk of hyperlactatemia.
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10
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Smeltz AM, Arora H. Pro: Metabolic Acidosis SHOULD be Corrected With Sodium Bicarbonate in Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2021; 36:616-618. [PMID: 34774405 DOI: 10.1053/j.jvca.2021.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/16/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Alan M Smeltz
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Harendra Arora
- Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Outcomes Research Consortium, Cleveland, OH
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11
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Venema CS, Erasmus ME, Mariani M, Voors AA, Damman K. Post-transplant inotrope score is associated with clinical outcomes after adult heart transplantation. Clin Transplant 2021; 35:e14347. [PMID: 33969543 PMCID: PMC8519078 DOI: 10.1111/ctr.14347] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Inotrope score has been proposed as a marker of clinical outcome after adult heart transplantation (HTx) but is rarely used in practice. METHODS Inotrope score during the first 48 h after HTx was calculated in 81 patients as: dopamine + dobutamine + amrinone + milrinone (dose × 15) + epinephrine (dose × 100) + norepinephrine (dose × 100) + enoximone + isoprenaline (dose × 100), with each drug in µg/kg/min. Determinants of inotrope score were identified with linear regression. Cox regression was used to determine the association of inotrope score with mortality. RESULTS The mean recipient age was 52 ± 11 years, and 32 (39.5%) patients were female. Determinants of inotrope score were preoperative C-reactive protein, serum urea, congenital heart disease, and donor cardiac arrest (R2 = .30). Inotrope score was associated with 5-year mortality, independent of recipient age and gender (HR 1.03, 95% CI 1.00-1.07). This association was attenuated when adjusting for female-to-male transplant and ischemia time. Inotrope score was also strongly associated with continuous veno-venous hemofiltration (OR 1.07, 95% CI 1.03-1.12). CONCLUSION High inotrope score post-HTx was observed in recipient congenital heart disease and was associated with a higher risk of mortality and acute kidney injury.
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Affiliation(s)
- Constantijn S. Venema
- Department of Cardiothoracic SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
- Department of CardiologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Michiel E. Erasmus
- Department of Cardiothoracic SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Massimo Mariani
- Department of Cardiothoracic SurgeryUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Adriaan A. Voors
- Department of CardiologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Kevin Damman
- Department of CardiologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
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12
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Ramírez-Ramos CF, Saldarriaga-Giraldo CI, Yepes-Calderón M, Castilla-Agudelo GA, Aránzazu Uribe M, Saldarriaga Betancur S, Casto P, Gallego C, Londoño A, Rendon-Isaza JC, Cañas E, Porras Á, Uribe-Molano JD. Arterial lactate levels and their prognostic value in patients undergoing pulmonary thromboendarterectomy. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2021; 2:96-102. [PMID: 38274565 PMCID: PMC10809776 DOI: 10.47487/apcyccv.v2i2.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/24/2021] [Indexed: 01/27/2024]
Abstract
Objective Evaluate the change of lactate levels and its prognostic role in the postoperative period of patients undergoing pulmonary thromboendarterectomy. Methods Retrospective study between 2001 and 2019. Patients older than 18 years and who underwent pulmonary thromboendarterectomy were included. The U Mann Whitney test was performed to evaluate the change between lactate levels, and Cox regression analysis to evaluate the relationship with mortality. Areas under the curve were constructed for lactate levels. Results Seventy-three patients were operated on during the study period. Median age was 51 years, 55% female. The median lactate on days 1 was 4.65 mml/L and on day 2 it was 1.62 mml/L with a change of 2.87 mml/L. No differences were found between the levels measured on day 1 and 2 between the people who died and those who did not on day 30. In the multivariate regression of COX, no relationship with mortality was found. The area under the curve shows regular performance on both day 1 and day 2 in predicting mortality outcomes. Conclusions The behavior of the lactate in patients undergoing pulmonary thromboendarterectomy shows a rapid change during the first hours after the procedure. No role was found as a predictor of mortality neither in-hospital nor in follow-up.
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Affiliation(s)
- Cristhian Felipe Ramírez-Ramos
- Department of Cardiology, Universidad Pontificia Bolivariana, Clínica CardioVID. Medellin, Colombia. Universidad Pontificia BolivarianaDepartment of CardiologyUniversidad Pontificia BolivarianaClínica CardioVIDMedellinColombia
| | - Clara Inés Saldarriaga-Giraldo
- Department of Cardiology and Heart Failure, Universidad Pontificia Bolivariana, Clínica CardioVID. Universidad de Antioquia. Medellin, Colombia. Universidad Pontificia BolivarianaDepartment of Cardiology and Heart FailureUniversidad Pontificia BolivarianaClínica CardioVIDMedellinColombia
| | - Manuela Yepes-Calderón
- Universidad de Antioquia. Medellin, Colombia. Universidad de AntioquiaUniversidad de AntioquiaMedellinColombia
| | - Gustavo Adolfo Castilla-Agudelo
- Department of Cardiology, Universidad Pontificia Bolivariana, Clínica CardioVID. Medellin, Colombia. Universidad Pontificia BolivarianaDepartment of CardiologyUniversidad Pontificia BolivarianaClínica CardioVIDMedellinColombia
| | - Mateo Aránzazu Uribe
- Department of Internal Medicine, Universidad Pontificia Bolivariana, Clínica CardioVID. Medellin, Colombia. Universidad Pontificia BolivarianaDepartment of Internal MedicineUniversidad Pontificia BolivarianaClínica CardioVIDMedellinColombia
| | - Santiago Saldarriaga Betancur
- Department of Internal Medicine, Universidad Pontificia Bolivariana, Clínica CardioVID. Medellin, Colombia. Universidad Pontificia BolivarianaDepartment of Internal MedicineUniversidad Pontificia BolivarianaClínica CardioVIDMedellinColombia
| | - Paulina Casto
- Department of Anesthesiology Universidad Pontificia Bolivariana, Clínica CardioVID. Medellin, Colombia. Universidad Pontificia BolivarianaDepartment of AnesthesiologyUniversidad Pontificia BolivarianaClínica CardioVIDMedellinColombia
| | - Catalina Gallego
- Department of Cardiology and Heart Failure, Universidad Pontificia Bolivariana, Clínica CardioVID. Universidad de Antioquia. Medellin, Colombia. Universidad Pontificia BolivarianaDepartment of Cardiology and Heart FailureUniversidad Pontificia BolivarianaClínica CardioVIDMedellinColombia
| | - Alejandro Londoño
- Department of Pulmonology and Pulmonary Hypertension Clinic, Clínica CardioVID. Medellin, Colombia. Department of Pulmonology and Pulmonary Hypertension ClinicClínica CardioVIDMedellinColombia
| | - Juan Camilo Rendon-Isaza
- Cardiovascular Surgery Department, Universidad Pontificia Bolivariana Clínica CardioVID. Medellin, Colombia. Pontificia Universidad BolivarianaCardiovascular Surgery DepartmentUniversidad Pontificia BolivarianaClínica CardioVIDMedellinColombia
| | - Eliana Cañas
- Department of Epidemiology, Universidad Pontificia Bolivariana, Clínica CardioVID. Medellin, Colombia. Universidad Pontificia BolivarianaDepartment of EpidemiologyUniversidad Pontificia BolivarianaClínica CardioVIDMedellinColombia
| | - Álvaro Porras
- Department of Intensive Care Medicine and Cardiovascular Intensive Care, Clínica CardioVID. Medellin, Colombia. Department of Intensive Care Medicine and Cardiovascular Intensive CareClínica CardioVIDMedellinColombia
| | - Juan David Uribe-Molano
- Department of Intensive Care Medicine and Cardiovascular Intensive Care, Clínica CardioVID. Medellin, Colombia. Department of Intensive Care Medicine and Cardiovascular Intensive CareClínica CardioVIDMedellinColombia
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Stephens EH, Epting CL, Backer CL, Wald EL. Hyperlactatemia: An Update on Postoperative Lactate. World J Pediatr Congenit Heart Surg 2021; 11:316-324. [PMID: 32294015 DOI: 10.1177/2150135120903977] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
While hyperlactatemia in postoperative cardiac surgery patients was once believed to solely reflect hypoperfusion, either from the accumulated "oxygen debt" during bypass or ongoing inadequate perfusion, our understanding of lactate generation, clearance, and management has evolved. A contemporary understanding of lactate balance is critical to the management of the postoperative patient with hyperlactatemia. In this review, we summarize the current understanding of lactate metabolism in pediatric patients following cardiac surgery and highlight two types of hyperlactatemia: type A, which is secondary to inadequate oxygen delivery and tissue hypoxia, and type B, which in postoperative pediatric cardiac surgery patients largely reflects increased glycolysis driven by the stress response. Both types may coexist; thus, it is imperative that providers first assess the patient for evidence of hypoperfusion. In patients with evidence of adequate perfusion, a type B component is often associated with a concomitant balanced (normal anion gap) metabolic acidosis and hyperglycemia. These patients will benefit from a more nuanced approach to their type B hyperlactatemia, as many will have a benign course and may be managed expectantly.
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Affiliation(s)
- Elizabeth H Stephens
- Division of Cardiovascular-Thoracic Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Conrad L Epting
- Divisions of Critical Care and Cardiology, Department of Pediatrics, Northwestern University, Chicago, IL, USA.,Pathology, Northwestern University, Chicago, IL, USA
| | - Carl L Backer
- Division of Cardiovascular-Thoracic Surgery, Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Eric L Wald
- Divisions of Critical Care and Cardiology, Department of Pediatrics, Northwestern University, Chicago, IL, USA
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Barkhuizen M, Abella R, Vles JSH, Zimmermann LJI, Gazzolo D, Gavilanes AWD. Antenatal and Perioperative Mechanisms of Global Neurological Injury in Congenital Heart Disease. Pediatr Cardiol 2021; 42:1-18. [PMID: 33373013 PMCID: PMC7864813 DOI: 10.1007/s00246-020-02440-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/17/2020] [Indexed: 12/01/2022]
Abstract
Congenital heart defects (CHD) is one of the most common types of birth defects. Thanks to advances in surgical techniques and intensive care, the majority of children with severe forms of CHD survive into adulthood. However, this increase in survival comes with a cost. CHD survivors have neurological functioning at the bottom of the normal range. A large spectrum of central nervous system dysmaturation leads to the deficits seen in critical CHD. The heart develops early during gestation, and CHD has a profound effect on fetal brain development for the remainder of gestation. Term infants with critical CHD are born with an immature brain, which is highly susceptible to hypoxic-ischemic injuries. Perioperative blood flow disturbances due to the CHD and the use of cardiopulmonary bypass or circulatory arrest during surgery cause additional neurological injuries. Innate patient factors, such as genetic syndromes and preterm birth, and postoperative complications play a larger role in neurological injury than perioperative factors. Strategies to reduce the disability burden in critical CHD survivors are urgently needed.
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Affiliation(s)
- Melinda Barkhuizen
- Department of Pediatrics and Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Raul Abella
- Department of Pediatric Cardiac Surgery, University of Barcelona, Vall d'Hebron, Spain
| | - J S Hans Vles
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Luc J I Zimmermann
- Department of Pediatrics and Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Diego Gazzolo
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Fetal, Maternal and Neonatal Health, C. Arrigo Children's Hospital, Alessandria, Italy
| | - Antonio W D Gavilanes
- Department of Pediatrics and Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
- Instituto de Investigación e Innovación de Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Guayaquil, Guayaquil, Ecuador.
- Department of Pediatrics, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands.
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15
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Han D, Pan S, Li H, Meng L, Luo Y, Ou-Yang C. Prognostic value of cardiac cycle efficiency in children undergoing cardiac surgery: a prospective observational study. Br J Anaesth 2020; 125:321-329. [PMID: 32636084 DOI: 10.1016/j.bja.2020.05.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cardiac cycle efficiency (CCE) derived from a pressure-recording analytical method is a unique parameter to assess haemodynamic performance from an energetic view. This study investigated changes of CCE according to an anatomical diagnosis group, and its association with early postoperative outcomes in children undergoing cardiac surgery. METHODS Ninety children were included with a ventricular septal defect (VSD; n=30), tetralogy of Fallot (TOF; n=40), or total anomalous pulmonary venous connection (TAPVC; n=20). CCE along with other haemodynamic parameters, was recorded from anaesthesia induction until 48 h post-surgery. Predictive CCE (CCEp) was defined as the average of CCE at post-modified ultrafiltration and CCE at the end of surgery. The relationship between CCE and early outcomes was assessed by the comparison between the high-CCEp group (CCEp ≥75th centile) and the low-CCEp group (CCEp ≤25th centile). RESULTS There was a significant time × diagnostic group interaction effect in the trend of CCE. Compared with the high-CCEp group (n=23), the low-CCEp group (n=22) required more inotropics post-surgery, had higher lactate concentrations at 8 and 24 h post-surgery, a longer intubation time and longer ICU stay, and higher frequency of peritoneal fluid. CONCLUSIONS Perioperative changes of CCE vary according to anatomical diagnosis in children undergoing cardiac surgery. Children with TOF have an unfavourable trend of CCE compared with children with VSD or TAPVC. A decline in CCE is associated with adverse early postoperative outcomes. CLINICAL TRIAL REGISTRATION ChiCTR1800014996.
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Affiliation(s)
- Ding Han
- Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China
| | - Shoudong Pan
- Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China
| | - Hang Li
- Clinical Medicine, North China University of Science and Technology, Hebei, China
| | - Linghui Meng
- Department of Evidence based Medicine, Capital Institute of Paediatrics, Beijing, China
| | - Yi Luo
- Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China
| | - Chuan Ou-Yang
- Anaesthesia Department, Affiliated Children's Hospital, Capital Institute of Paediatrics, Beijing, China; Anaesthesia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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16
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Nasr VG, Staffa SJ, Boyle S, Regan W, Brown M, Smith-Parrish M, Kaza A, DiNardo JA. Predictors of Increased Lactate in Neonatal Cardiac Surgery: The Impact of Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth 2020; 35:148-153. [PMID: 32620493 DOI: 10.1053/j.jvca.2020.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Hyperlactatemia develops intraoperatively during cardiac surgery and is associated with postoperative mortality. This study aimed to determine the factors that lead to an increase in lactate during cardiopulmonary bypass (CPB) in neonates undergoing cardiac surgery. DESIGN Retrospective study from July 2015 to December 2018. SETTING Academic tertiary children's hospital. PARTICIPANTS The study comprised 376 neonates. INTERVENTIONS No interventions were performed. MEASUREMENTS AND MAIN RESULTS Lactate measurements at prebypass, upon initiation of CPB and before coming off CPB, last in the operating room, and first in the cardiac intensive care unit were collected. The changes in lactate levels were compared using the nonparametric Wilcoxon signed rank test for paired data. Univariate and multivariate median regression models of the change during CPB were determined. The cohort characteristics were male (60%), median age 5 days (range 1-30), and weight 3.2 kg (range 1.5-4.7). Most patients had a STAT score of 4 (45%) or 5 (23%). Significant increases in lactate were observed from pre-CPB to start of CPB (p < 0.001) and from start to end of CPB (p < 0.001). In the multivariate regression analysis, duration of circulatory arrest (coefficient = 1.216; 95% confidence interval [CI] 0.754-1.678; p < 0.001), duration of mean arterial pressure < 25 mmHg (coefficient = 0.423; 95% CI 0.196-to- 0.651; p < 0.001), and duration of mean arterial pressure between 35 and 39 mmHg (coefficient = -0.246; 95% CI -0.397 to -0.095; p = 0.001) were identified as significant independent predictors of the lactate change per 30- minutes duration. CONCLUSION These results emphasized the importance of blood pressure management during CPB and the importance of the duration of circulatory arrest.
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Affiliation(s)
- Viviane G Nasr
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Sharon Boyle
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - William Regan
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Morgan Brown
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Melissa Smith-Parrish
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Aditya Kaza
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - James A DiNardo
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Kim J, Wu A, Grogan T, Wingert T, Scovotti J, Kratzert W, Neelankavil JP. Frequency and Outcomes of Elevated Perioperative Lactate Levels in Adult Congenital Heart Disease Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth 2020; 34:2641-2647. [PMID: 32139342 DOI: 10.1053/j.jvca.2020.01.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To assess whether lactate levels are associated with clinical outcomes in adult congenital heart disease patients who undergo cardiac surgery. DESIGN Retrospective study. SETTING Single quaternary academic referral center. PARTICIPANTS Adult congenital heart disease patients (≥18 y old) with congenital heart disease undergoing cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Participants were classified into 3 groups according to their peak arterial lactate level within the first 48 hours of surgery. MEASUREMENTS AND MAIN RESULTS In-hospital 30-day mortality, hospital and intensive care unit length of stay, duration of mechanical ventilation after surgery, acute kidney injury defined by Acute Kidney Injury Network criteria, and intensive care unit and hospital readmission within 30 days of surgery were examined. There was no significant difference among different lactate level groups in acute kidney injury, hospital length of stay, intensive care unit length of stay, hours of mechanical ventilation, need for redo surgery, or rates of hospital or intensive care unit readmission. In multivariable analysis, which included cardiopulmonary bypass time, redo surgery, nonelective case, and the adult congenital heart disease complexity score, lactate levels were not a significant predictor of either acute kidney injury or hospital length of stay. CONCLUSIONS The appeal of using lactate levels to risk stratify-patients or to develop a model to predict mortality and morbidity has potential merit, but currently there is insufficient evidence to use lactate levels as a predictor of outcomes in adult patients with congenital heart disease undergoing cardiac surgery.
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Affiliation(s)
- Jeffrey Kim
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Andrew Wu
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Tristan Grogan
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Theodore Wingert
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jennifer Scovotti
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Wolf Kratzert
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - J Prince Neelankavil
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
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18
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“Benign” lactic acidosis is common in adolescents and children following congenital heart surgery. PROGRESS IN PEDIATRIC CARDIOLOGY 2019. [DOI: 10.1016/j.ppedcard.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Outcome Prediction Following Complex Congenital Heart Disease Operations-The Intensivist Perspective. Pediatr Crit Care Med 2018; 19:1083-1084. [PMID: 30395109 DOI: 10.1097/pcc.0000000000001702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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VanLoozen DH, Murdison KA, Polimenakos AC. Neonatal Myocardial Perfusion in Right Ventricle Dependent Coronary Circulation: Clinical Surrogates and Role of Troponin-I in Postoperative Management Following Systemic-to-Pulmonary Shunt Physiology. Pediatr Cardiol 2018; 39:1496-1499. [PMID: 30056521 DOI: 10.1007/s00246-018-1940-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/21/2018] [Indexed: 11/29/2022]
Abstract
Right ventricle dependent coronary circulation (RVDCC) in pulmonary atresia with intact ventricular septum (PA/IVS) is associated with significant mortality risk in the immediate post-operative period following the initial stage of surgical palliation. Prognosis remains guarded during the interstage period towards conversion to the superior cavopulmonary shunt physiology. Current literature is scarce regarding this specific patient population. Cardiac troponin-I is widely used as a marker of coronary ischemia in adults, but its use for routine monitoring of neonatal myocardial tissue injury due to supply/demand perfusion mismatch is, yet to be determined. We sought to evaluate the clinical correlation of cTnl perioperative use in a PA/IVS RVDCC case and assess its interplay with established clinical, echocardiographic, and laboratory variables in guiding a real-time (dynamic) management strategy following systemic-to-pulmonary shunt palliation.
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Affiliation(s)
- Dennis H VanLoozen
- Department of Pediatric Cardiology, Children's Hospital of Georgia, Augusta University, 1120 15th Street BA 8300, Augusta, GA, 30912, USA. .,Children's Hospital of Georgia, Augusta University, 1446 Harper Street, BA-8300, Augusta, GA, 30912, USA.
| | - Kenneth A Murdison
- Department of Pediatric Cardiology, Children's Hospital of Georgia, Augusta University, 1120 15th Street BA 8300, Augusta, GA, 30912, USA
| | - Anastasios C Polimenakos
- Department of Pediatric Cardiothoracic Surgery, Children's Hospital of Georgia, Augusta University, 1120 15th Street, Augusta, GA, 30912, USA
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21
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Correlation between serum lactate levels and outcome in pediatric patients undergoing congenital heart surgery. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:375-385. [PMID: 32082767 DOI: 10.5606/tgkdc.dergisi.2018.15791] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/23/2018] [Indexed: 11/21/2022]
Abstract
Background This study aimed to investigate the correlation between perioperative arterial lactate levels and morbidity and mortality in children undergoing cardiac surgery. Methods A total of 236 patients who underwent open heart surgery due to congenital heart disease (121 males, 115 females; mean age 56.4 month (median: 42 month): range, 1 day to 204 month) between June 2014 and May 2016 were retrospectively analyzed. The arterial blood gas analysis results at baseline (after insertion of arterial cannula), during the cooling and warming-up phases in cardiopulmonary bypass, during the sternal closure, and at 0, 6, 12, and 24 hours in the postoperative intensive care unit stay were recorded. The patients were divided into two groups according to their lactate levels: Group 1 (lactate level <4.5 mmol/L, n=183) and Group 2 (lactate level ≥4.5 mmol/L, n=53). Correlation between the lactate groups and demographic data, intraoperative and postoperative variables, postoperative complications, and mortality were investigated. Results Sixty-nine patients (29.2%) had cyanotic heart disease. A total of 53 patients (22.5%) had lactate levels of ≥4.5 mmol/L. At least one complication occurred in 41% of the patients. Development of at least one complication (p=0.027) and mortality rate (p<0.001) were significantly higher in the patients with lactate levels of ≥4.5 mmol/L. Seventeen patients (7.2%) died in the postoperative period, and 15 of them had lactate levels of ≥4.5 mmol/L at least once within the first 24 hours. In terms of mortality, lactate levels of ≥4.5 mmol/L at any time, prolonged mechanical ventilation (>48 hours), and undergoing complex surgery (high the Risk-adjusted Classification for Congenital Heart Surgery-1 score, category 4-6) were the independent risk factors for mortality. Conclusion Blood arterial lactate level of ≥4.5 mmol/L was found to be a risk factor for postoperative morbidity and mortality in pediatric patients undergoing congenital heart surgery.
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Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass. J Anesth 2018; 32:167-173. [DOI: 10.1007/s00540-018-2447-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/02/2018] [Indexed: 01/01/2023]
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Patki VK, Antin JV, Khare SH. Persistent Hyperlactatemia as the Predictor of Poor Outcome in Critically Ill Children: A Single-Center, Prospective, Observational Cohort Study. J Pediatr Intensive Care 2017; 6:152-158. [PMID: 31073441 DOI: 10.1055/s-0036-1593886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022] Open
Abstract
Objective To study incidence of hyperlactatemia and its correlation with outcome in critically ill children. Design Single-center, prospective cohort study. Setting Eight-bedded PICU. Method Serial serum lactate levels were measured in 140 critically ill children at 0, 12, 24, and 48 hours. Results A total of 45% children had hyperlactatemia. Lactate levels were significantly ( p = 0.000) higher in nonsurvivors at all intervals. Lactate levels decreased significantly ( p = 0.000) in survivors while increased in nonsurvivors. Normalized lactate load was found to be an independent predictor of mortality ( p = 0.023). Conclusion Persistent hyperlactatemia serves as a possible predictor of poor outcome in critically ill children.
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Affiliation(s)
- Vinayak K Patki
- Department of Pediatrics, Institute of Medical Education and Research, Vidyagiri, Satara, Maharashtra, India
| | - Jennifer V Antin
- Department of Pediatrics, Wanless Hospital, Miraj, Sangli, Maharashtra, India
| | - Shweta H Khare
- Department of Pediatrics, Wanless Hospital, Miraj, Sangli, Maharashtra, India
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The Total Inotrope Exposure Score: an extension of the Vasoactive Inotrope Score as a predictor of adverse outcomes after paediatric cardiac surgery. Cardiol Young 2017; 27:1146-1152. [PMID: 28287056 DOI: 10.1017/s1047951116002602] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of the present study was to explore and compare the association between a new vasoactive score - the Total Inotrope Exposure Score - and outcome and the established Vasoactive Inotrope Score in children undergoing cardiac surgery with cardiopulmonary bypass DESIGN: The present study was a single-centre, retrospective study. SETTING The study was carried out at a 21-bed cardiovascular ICU in a Tertiary Children's Hospital between September, 2010 and May, 2011 METHODS: The Total Inotrope Exposure Score is a new vasoactive score that brings together cumulative vasoactive drug exposure and incorporates dose adjustments over time. The performance of these scores - average, maximum Vasoactive Inotrope Score at 24 and 48 hours, and Total Inotrope Exposure Score - to predict primary clinical outcomes - either death, cardiopulmonary resuscitation, or extra-corporeal membrane oxygenation before hospital discharge - and secondary outcomes - length of invasive mechanical ventilation, length of ICU stay, and hospital stay - was calculated. Main results The study cohort included 167 children under 18 years of age, with 37 (22.2%) neonates and 65 (41.3%) infants aged between 1 month and 1 year. The Total Inotrope Exposure Score best predicted the primary outcome (six of 167 cases) with an unadjusted odds ratio for a poor outcome of 42 (4.8, 369.6). Although the area under curve was higher than other scores, this difference did not reach statistical significance. The Total Inotrope Exposure Score best predicted prolonged invasive mechanical ventilation, length of ICU stay, and hospital stay as compared with the other scores. CONCLUSION The Total Inotrope Exposure Score appears to have a good association with poor postoperative outcomes and warrants prospective validation across larger numbers of patients across institutions.
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Ladha S, Kapoor PM, Singh SP, Kiran U, Chowdhury UK. The role of blood lactate clearance as a predictor of mortality in children undergoing surgery for tetralogy of Fallot. Ann Card Anaesth 2017; 19:217-24. [PMID: 27052060 PMCID: PMC4900343 DOI: 10.4103/0971-9784.179589] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: The identification of biomarkers for predicting morbidity and mortality, particularly in pediatric population undergoing cardiac surgery will contribute toward improving the patient outcome. There is an increasing body of literature establishing the clinical utility of hyperlactatemia and lactate clearance as prognostic indicator in adult cardiac surgical patients. However, the relationship between lactate clearance and mortality risk in the pediatric population remains to be established. Objective: To assess the role of lactate clearance in determining the outcome in children undergoing corrective surgery for tetralogy of Fallot (TOF). Methods and Study Design: A prospective, observational study. Setting: A tertiary care center. Study Population: Two hundred children undergoing elective surgery for TOF. Study Method: Blood lactate levels were obtained as baseline before operation (T0), postoperatively at admission to the cardiac intensive care unit after surgery (T1), and then at every 6 h for the first 24 h of Intensive Care Unit (ICU) stay (T6, T12, T18, and T24, respectively). The lactate clearance in the study is defined by the equation ([lactate initial – lactate delayed]/lactate initial) ×100%. Lactate clearance was determined at T1–T6, T1–T12, T1–T18, and T1–T24 time interval, respectively. The primary outcome measured was mortality. Secondary outcomes measured were the duration of mechanical ventilation, duration of inotropic requirement, and duration of ICU stay. Results: Eleven out of the two hundred patients enrolled in the study died. Nonsurvivors had higher postoperative lactate concentration (P < 0.05) and low-blood lactate clearance rate during 24 h (P < 0.05) in comparison to the survivors. Lactate clearance was significantly higher in survivors than in nonsurvivors for the T1–T6 period (19.55 ± 14.28 vs. 5.24 ± 27.79%, P = 0.009) and remained significantly higher for each studied interval in first 24 h. Multivariate logistic regression analysis of statistically significant univariate variables showed early lactate clearance to have a significant relationship with mortality. Patients with a lactate clearance >10%, relative to patients with a lactate clearance <10%, in the early postoperative period, had improved outcome and lower mortality. Conclusion: Lactate clearance in the early postoperative period (6 h) is associated with decreased mortality rate. Patients with higher lactate clearance (>10%) after 6 h have improved outcome compared with those with lower lactate clearance.
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Affiliation(s)
| | - Poonam Malhotra Kapoor
- Department of Cardiac Anesthesia, C. N. Centre, All India Institute of Medical Sciences, New Delhi, India
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Naik R, George G, Karuppiah S, Philip MA. Hyperlactatemia in patients undergoing adult cardiac surgery under cardiopulmonary bypass: Causative factors and its effect on surgical outcome. Ann Card Anaesth 2016; 19:668-675. [PMID: 27716698 PMCID: PMC5070327 DOI: 10.4103/0971-9784.191579] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/11/2016] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES OF THE STUDY To identify the factors causing high lactate levels in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) and to assess the association between high blood lactate levels and postoperative morbidity and mortality. METHODS A retrospective observational study including 370 patients who underwent cardiac surgeries under cardiopulmonary bypass. The patients were divided into 2 groups based on serum lactate levels; those with serum lactate levels greater than or equal to 4 mmol/L considered as hyperlactatemia and those with serum lactate levels less than 4 mmol/L. Blood lactate samples were collected intraoperatively and postoperatively in the ICU. Preoperative and intraoperative risk factors for hyperlactatemia were identified using the highest intraoperative value of lactate. The postoperative morbidity and mortality associated with hyperlactatemia was studied using the overall (intraoperative and postoperative values) peak lactate levels. Preoperative clinical data, perioperative events and postoperative morbidity and mortality were recorded. RESULTS Intraoperative peak blood lactate levels of 4.0 mmol/L or more were present in 158 patients (42.7%). Females had higher peak intra operative lactate levels (P = 0.011). There was significant correlation between CPB time (Pearson correlation coefficient r = 0.024; P = 0.003) and aortic cross clamp time (r = 0.02, P = 0.007) with peak intraoperative blood lactate levels. Patients with hyperlactatemia had significantly higher rate of postoperative morbidity like atrial fibrillation (19.9% vs. 5.3%; P = 0.004), prolonged requirement of inotropes (34% vs. 11.8%; P = 0.001), longer stay in the ICU (P = 0.013) and hospital (P = 0.001). CONCLUSIONS Hyperlactatemia had significant association with post-operative morbidity. Detection of hyperlactatemia in the perioperative period should be considered as an indicator of inadequate tissue oxygen delivery and must be aggressively corrected.
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Affiliation(s)
- Rakesh Naik
- Department of Cardiothoracic and Vascular Surgery, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Gladdy George
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sathappan Karuppiah
- Department of Anaesthesia, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Madhu Andrew Philip
- Department of Cardiothoracic Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Factors Affecting Breathing Capacity and Early Tracheal Extubation After Liver Transplantation. Transplant Proc 2016; 48:1692-6. [DOI: 10.1016/j.transproceed.2016.01.053] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/21/2016] [Indexed: 12/13/2022]
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Prostaglandin Availability and Association with Outcomes for Infants with Congenital Heart Disease. Pediatr Cardiol 2016; 37:338-44. [PMID: 26499357 DOI: 10.1007/s00246-015-1282-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/09/2015] [Indexed: 10/22/2022]
Abstract
Data regarding availability of prostaglandin E1 (PGE) and its impact on the stabilization, transport, critical care course, and surgical outcome of infants with ductal-dependent congenital heart disease in the current pediatric healthcare environment are unknown. We sought to determine the proportion of hospitals in Texas that stock PGE and to investigate associations between PGE availability and clinical outcomes. All birth institutions listed with the Texas Department of Health and Human Services were contacted to determine PGE availability as of 2011. Outcomes of all infants admitted to our institution from 2007 to 2012 who received PGE for ductal-dependent lesions were evaluated. PGE was stocked in 50 % (n = 139) of hospitals that performed deliveries in Texas in 2011 representing 79.1 % (303, 481) of births. Hospitals that did not stock PGE had less annual births and were located a further distance from a center that provided pediatric cardiac surgical services. Patients born at a hospital that did not stock PGE had significantly greater serum lactate and creatinine (p = 0.002) and serum lactate on admission (p < 0.001). The PGE availability was not associated with hospital length of stay, postoperative length of stay, or mortality. When stratifying in TGA and HLHS subgroups, lack of PGE availability remained associated with higher creatinine, higher lactate, lower glucose, and lower pH. PGE is not universally available in all healthcare institutions providing obstetrical services. Lack of availability of PGE at an outlying hospital was associated with increased morbidity, but was not associated with mortality or length of stay.
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Rodríguez-Balderrama I, Ostia-Garza P, Villarreal-Parra R, Tijerina-Guajardo M. Risk factors and the relation of lactic acid to neonatal mortality in the first week of life. MEDICINA UNIVERSITARIA 2016. [DOI: 10.1016/j.rmu.2015.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Chung HS, Lee S, Kwon SJ, Park CS. Perioperative predictors for refractory hyperglycemia during the neohepatic phase of liver transplantation. Transplant Proc 2015; 46:3474-80. [PMID: 25498075 DOI: 10.1016/j.transproceed.2014.06.078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 06/17/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Hyperglycemia in the neohepatic phase of liver transplantation (LT) tends to decrease toward completion of the surgical procedure. Refractory hyperglycemia in the neohepatic phase (RH) is influenced by multiple perioperative factors and may be connected to posttransplant outcomes. We attempted to demonstrate the relationship of RH to posttransplant outcomes and to establish a predictive model for RH in living donor liver transplantation (LDLT). METHODS Perioperative data of 211 patients who underwent LDLT from 2009 and 2012 were reviewed, including declines in the blood glucose levels during the neohepatic phase. Perioperative variables including the posttransplant model for end-stage liver disease (MELD) score until day 30 were compared between patients with normal declines in blood glucose and patients with RH. Selected variables after intergroup comparisons were examined by means of multivariate logistic regression to establish a predictive model for RH occurrence. RESULTS The mean blood glucose decline was 22.3 ± 31.5 mg/dL during the neohepatic phase, and 84 of 203 patients (41.4%) had no decline in blood glucose. In intergroup comparisons, preoperative factors associated with RH included sex, Child-Pugh-Turcotte class, MELD score, emergency, liver enzymes, and graft-to-recipient weight ratio. During surgery, surgical time, serum lactate, and arterial pH were associated with RH. After surgery, the RH group showed slower recovery of the MELD score (15.2 versus 11.9 days) and higher MELD scores until day 10 (P < .05). After the multivariate analysis, recipient sex, emergency, surgical time (≤9 h), and the final intraoperative serum lactate level (≥5.0 mmol/L) were included in the predictive model for RH. CONCLUSIONS RH was associated with delayed functional recovery of the liver graft in LT. Recipient sex, emergency, surgical time, and the final intraoperative serum lactate level were identified as predictors of RH. Close monitoring of intraoperative blood glucose in LDLT may be an early prognostic indicator.
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Affiliation(s)
- H S Chung
- Department of Anesthesiology and Pain Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S Lee
- Department of Anesthesiology and Pain Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - S J Kwon
- Department of Anesthesiology and Pain Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - C S Park
- Department of Anesthesiology and Pain Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Palermo RA, Palac HL, Wald EL, Wainwright MS, Costello JM, Eltayeb OM, Backer CL, Epting CL. Metabolic Uncoupling Following Cardiopulmonary Bypass. CONGENIT HEART DIS 2015. [DOI: 10.1111/chd.12285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Robert A. Palermo
- Department of Pediatrics; Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago Ill USA
| | - Hannah L. Palac
- Department of Preventive Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago Ill USA
| | - Eric L. Wald
- Department of Pediatrics; Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago Ill USA
| | - Mark S. Wainwright
- Department of Pediatrics; Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago Ill USA
| | - John M. Costello
- Department of Pediatrics; Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago Ill USA
| | - Osama M. Eltayeb
- Department of Surgery; Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago Ill USA
| | - Carl L. Backer
- Department of Surgery; Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago Ill USA
| | - Conrad L. Epting
- Department of Pediatrics; Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago Ill USA
- Department of Pathology; Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine; Chicago Ill USA
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Lam VH, Zhang L, Huqi A, Fukushima A, Tanner BA, Onay-Besikci A, Keung W, Kantor PF, Jaswal JS, Rebeyka IM, Lopaschuk GD. Activating PPARα prevents post-ischemic contractile dysfunction in hypertrophied neonatal hearts. Circ Res 2015; 117:41-51. [PMID: 25977309 DOI: 10.1161/circresaha.117.306585] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/14/2015] [Indexed: 11/16/2022]
Abstract
RATIONALE Post-ischemic contractile dysfunction is a contributor to morbidity and mortality after the surgical correction of congenital heart defects in neonatal patients. Pre-existing hypertrophy in the newborn heart can exacerbate these ischemic injuries, which may partly be due to a decreased energy supply to the heart resulting from low fatty acid β-oxidation rates. OBJECTIVE We determined whether stimulating fatty acid β-oxidation with GW7647, a peroxisome proliferator-activated receptor-α (PPARα) activator, would improve cardiac energy production and post-ischemic functional recovery in neonatal rabbit hearts subjected to volume overload-induced cardiac hypertrophy. METHODS AND RESULTS Volume-overload cardiac hypertrophy was produced in 7-day-old rabbits via an aorto-caval shunt, after which, the rabbits were treated with or without GW7647 (3 mg/kg per day) for 14 days. Biventricular working hearts were subjected to 35 minutes of aerobic perfusion, 25 minutes of global no-flow ischemia, and 30 minutes of aerobic reperfusion. GW7647 treatment did not prevent the development of cardiac hypertrophy, but did prevent the decline in left ventricular ejection fraction in vivo. GW7647 treatment increased cardiac fatty acid β-oxidation rates before and after ischemia, which resulted in a significant increase in overall ATP production and an improved in vitro post-ischemic functional recovery. A decrease in post-ischemic proton production and endoplasmic reticulum stress, as well as an activation of sarcoplasmic reticulum calcium ATPase isoform 2 and citrate synthase, was evident in GW7647-treated hearts. CONCLUSIONS Stimulating fatty acid β-oxidation in neonatal hearts may present a novel cardioprotective intervention to limit post-ischemic contractile dysfunction.
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Affiliation(s)
- Victoria H Lam
- From the Cardiovascular Translational Science Institute (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.) and Department of Pediatrics (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.), University of Alberta, Edmonton, Canada; and Department of Medical Pharmacology, Ankara University, Ankara, Turkey (A.O.-B.)
| | - Liyan Zhang
- From the Cardiovascular Translational Science Institute (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.) and Department of Pediatrics (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.), University of Alberta, Edmonton, Canada; and Department of Medical Pharmacology, Ankara University, Ankara, Turkey (A.O.-B.)
| | - Alda Huqi
- From the Cardiovascular Translational Science Institute (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.) and Department of Pediatrics (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.), University of Alberta, Edmonton, Canada; and Department of Medical Pharmacology, Ankara University, Ankara, Turkey (A.O.-B.)
| | - Arata Fukushima
- From the Cardiovascular Translational Science Institute (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.) and Department of Pediatrics (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.), University of Alberta, Edmonton, Canada; and Department of Medical Pharmacology, Ankara University, Ankara, Turkey (A.O.-B.)
| | - Brandon A Tanner
- From the Cardiovascular Translational Science Institute (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.) and Department of Pediatrics (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.), University of Alberta, Edmonton, Canada; and Department of Medical Pharmacology, Ankara University, Ankara, Turkey (A.O.-B.)
| | - Arzu Onay-Besikci
- From the Cardiovascular Translational Science Institute (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.) and Department of Pediatrics (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.), University of Alberta, Edmonton, Canada; and Department of Medical Pharmacology, Ankara University, Ankara, Turkey (A.O.-B.)
| | - Wendy Keung
- From the Cardiovascular Translational Science Institute (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.) and Department of Pediatrics (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.), University of Alberta, Edmonton, Canada; and Department of Medical Pharmacology, Ankara University, Ankara, Turkey (A.O.-B.)
| | - Paul F Kantor
- From the Cardiovascular Translational Science Institute (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.) and Department of Pediatrics (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.), University of Alberta, Edmonton, Canada; and Department of Medical Pharmacology, Ankara University, Ankara, Turkey (A.O.-B.)
| | - Jagdip S Jaswal
- From the Cardiovascular Translational Science Institute (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.) and Department of Pediatrics (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.), University of Alberta, Edmonton, Canada; and Department of Medical Pharmacology, Ankara University, Ankara, Turkey (A.O.-B.)
| | - Ivan M Rebeyka
- From the Cardiovascular Translational Science Institute (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.) and Department of Pediatrics (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.), University of Alberta, Edmonton, Canada; and Department of Medical Pharmacology, Ankara University, Ankara, Turkey (A.O.-B.)
| | - Gary D Lopaschuk
- From the Cardiovascular Translational Science Institute (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.) and Department of Pediatrics (V.H.L., L.Z., A.H., A.F., B.A.T., W.K., P.F.K., J.S.J., I.M.R., G.D.L.), University of Alberta, Edmonton, Canada; and Department of Medical Pharmacology, Ankara University, Ankara, Turkey (A.O.-B.).
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Li CL, Wang H, Jia M, Ma N, Meng X, Hou XT. The early dynamic behavior of lactate is linked to mortality in postcardiotomy patients with extracorporeal membrane oxygenation support: A retrospective observational study. J Thorac Cardiovasc Surg 2015; 149:1445-50. [DOI: 10.1016/j.jtcvs.2014.11.052] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/31/2014] [Accepted: 11/19/2014] [Indexed: 11/17/2022]
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Abstract
OBJECTIVE To establish whether the use of near-infrared spectroscopy is potentially beneficial in high-risk cardiac infants in United Kingdom paediatric intensive care units. DESIGN A prospective observational pilot study. SETTING An intensive care unit in North West England. PATIENTS A total of 10 infants after congenital heart surgery, five with biventricular repairs and five with single-ventricle physiology undergoing palliation. INTERVENTIONS Cerebral and somatic near-infrared spectroscopy monitoring for 24 hours post-operatively in the intensive care unit. MEASUREMENT AND MAIN RESULTS Overall, there was no strong correlation between cerebral near-infrared spectroscopy and mixed venous oxygen saturation (r=0.48). At individual time points, the correlation was only strong (r=0.74) 1 hour after admission. The correlation was stronger for the biventricular patients (r=0.68) than single-ventricle infants (r=0.31). A strong inverse correlation was demonstrated between cerebral near-infrared spectroscopy and serum lactate at 3 of the 5 post-operative time points (1, 4, and 12 hours: r=-0.76, -0.72, and -0.69). The correlation was stronger when the cerebral near-infrared spectroscopy was <60%. For cerebral near-infrared spectroscopy <60%, the inverse correlation with lactate was r=-0.82 compared with those cerebral near-infrared spectroscopy >60%, which was r=-0.50. No correlations could be demonstrated between (average) somatic near-infrared spectroscopy and serum lactate (r=-0.13, n=110) or mixed venous oxygen saturation and serum lactate. There was one infant who suffered a cardiopulmonary arrest, and the cerebral near-infrared spectroscopy showed a consistent 43 minute decline before the event. CONCLUSIONS We found that cerebral near-infrared spectroscopy is potentially beneficial as a non-invasive, continuously displayed value and is feasible to use on cost-constrained (National Health Service) cardiac intensive care units in children following heart surgery.
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Development of an enzymatic chromatography strip with nicotinamide adenine dinucleotide-tetrazolium coupling reactions for quantitative l-lactate analysis. Anal Biochem 2014; 471:61-6. [PMID: 25454507 DOI: 10.1016/j.ab.2014.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/19/2014] [Accepted: 11/20/2014] [Indexed: 11/23/2022]
Abstract
In this study, a dry assay of l-lactate via the enzymatic chromatographic test (ECT) was developed. An l-lactate dehydrogenase plus a nicotinamide adenine dinucleotide (NADH) regeneration reaction were applied simultaneously. Various tetrazolium salts were screened to reveal visible color intensities capable of determining the lactate concentrations in the sample. The optimal analysis conditions were as follows. The diaphorase (0.5 μl, 2(-6)U/μl) was immobilized in the test line of the ECT strip. Nitrotetrazolium blue chloride (5 μl, 12 mM), l-lactate dehydrogenase (1 μl, 0.25U/μl), and NAD(+) (2μl, 1.5×10(-5)M) were added into the mobile phase (100 μl) composed of 0.1% (w/w) Tween 20 in 10mM phosphate buffer (pH 9.0), and the process was left to run for 10 min. This detection had a linear range of 0.039 to 5mM with a detection limit of 0.047 mM. This quantitative analysis process for l-lactate was easy to operate with good stability and was proper for the point-of-care testing applications.
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Fang Y, Long C, Lou S, Guan Y, Fu Z. Blood versus crystalloid cardioplegia for pediatric cardiac surgery: a meta-analysis. Perfusion 2014; 30:529-36. [PMID: 25336140 DOI: 10.1177/0267659114556402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Blood and crystalloid cardioplegia are the main myocardial protective solutions used in pediatric cardiac surgery. However, the effectiveness of these two solutions on myocardial metabolism, reperfusion injury and clinical outcomes in pediatric patients is still under debate. The purpose of this meta-analysis was to compare the efficacy of these two cardioplegia solutions in pediatric cardiac surgery. METHODS Keyword searches were performed on PUBMED, EMBASE and The Cochrane Library for randomized, controlled, clinical studies which were primarily comparing blood and crystalloid cardioplegia in pediatric cardiac surgery and provided data of postoperative cardiac troponin I (cTnI), lactate, mechanical ventilation time, length of intensive care unit (ICU) stay and inotropic support. Databases were searched from 1966 to June 2013 and were restricted to peer-reviewed English language publications of human subjects. We summarized the combined results of the data as mean difference (MD, when outcome measurements were made on the same scale) or standard mean difference (SMD, when the studies assess the same outcome with different scales), with 95% confidence intervals. RESULTS Five studies were identified, with a total of 323 patients. Lactate level after cardiopulmonary bypass (CPB) was significantly lower after blood cardioplegia compared with crystalloid cardioplegia (SMD 1.09, 95%CI 0.12 to 2.06, p=0.03); cTnI release postoperatively at 4-6 h (MD 0.92 ng/ml, 95%CI -0.13 to 1.97, p=0.09), 12 h (MD 0.2 ng/ml, 95% CI -0.43 to 0.84, p=0.53) and 24 h (MD 0.98 ng/ml, 95%CI -0.26 to 2.22, p=0.12) was not significantly different between the groups; ventilation duration (MD 5.15 hours, 95%CI -7.51 to 17.81, p=0.42) and length of ICU stay (SMD -0.3, 95%CI -0.80 to 0.21, p=0.25) were not significantly different between the groups either. CONCLUSION Myocardial metabolism was better in the blood cardioplegia group compared with the crystalloid cardioplegia group. However, there was no evidence of improvement in myocardial damage or clinical outcome for either cardioplegia solution.
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Affiliation(s)
- Y Fang
- Department of Extracorporeal Circulation, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - C Long
- Department of Extracorporeal Circulation, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - S Lou
- Department of Extracorporeal Circulation, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Y Guan
- Department of Extracorporeal Circulation, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Z Fu
- Department of Extracorporeal Circulation, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
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Lee S, Sa GJ, Kim SY, Park CS. Intraoperative predictors of early tracheal extubation after living-donor liver transplantation. Korean J Anesthesiol 2014; 67:103-9. [PMID: 25237446 PMCID: PMC4166381 DOI: 10.4097/kjae.2014.67.2.103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/19/2014] [Accepted: 02/07/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Prolonged mechanical ventilation after liver transplantation has been associated with deleterious clinical outcomes, so early tracheal extubation posttransplant is now increasing. However, there is no universal clinical criterion for predicting early extubation in living-donor liver transplantation (LDLT). We investigated specific predictors of early extubation after LDLT. METHODS Perioperative data of adult patients undergoing LDLT were reviewed. "Early" extubation was defined as tracheal extubation in the operating room or intensive care unit (ICU) within 1 h posttransplant, and we divided patients into early extubation (EX) and non-EX groups. Potentially significant (P < 0.10) perioperative variables from univariate analyses were entered into multivariate logistic regression analyses. Individual cut-offs of the predictors were calculated by area under the receiver operating characteristic curve (AUC) analysis. RESULTS Of 107 patients, 66 (61.7%) were extubated early after LDLT. Patients in the EX group showed shorter stays in the hospital and ICU and lower incidences of reoperation, infection, and vascular thrombosis. Preoperatively, model for end-stage liver disease score, lung disease, hepatic encephalopathy, ascites, and intraoperatively, surgical time, transfusion of packed red blood cell (PRBC), urine output, vasopressors, and last measured serum lactate were associated with early extubation (P < 0.05). After multivariate analysis, only PRBC transfusion of ≤ 7.0 units and last serum lactate of ≤ 8.2 mmol/L were selected as predictors of early extubation after LDLT (AUC 0.865). CONCLUSIONS Intraoperative serum lactate and blood transfusion were predictors of posttransplant early extubation. Aggressive efforts to ameliorate intraoperative circulatory issues would facilitate successful early extubation after LDLT.
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Affiliation(s)
- Serin Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Gye Jeol Sa
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Stephanie Youna Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chul Soo Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Vasoactive-inotropic score is associated with outcome after infant cardiac surgery: an analysis from the Pediatric Cardiac Critical Care Consortium and Virtual PICU System Registries. Pediatr Crit Care Med 2014; 15:529-37. [PMID: 24777300 PMCID: PMC4159673 DOI: 10.1097/pcc.0000000000000153] [Citation(s) in RCA: 286] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To empirically derive the optimal measure of pharmacologic cardiovascular support in infants undergoing cardiac surgery with bypass and to assess the association between this score and clinical outcomes in a multi-institutional cohort. DESIGN Prospective, multi-institutional cohort study. SETTING Cardiac ICUs at four academic children's hospitals participating in the Pediatric Cardiac Critical Care Consortium during the study period. PATIENTS Children younger than 1 year at the time of surgery treated postoperatively in the cardiac ICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Three hundred ninety-one infants undergoing surgery with bypass were enrolled consecutively from November 2011 to April 2012. Hourly doses of all vasoactive agents were recorded for the first 48 hours after cardiac ICU admission. Multiple derivations of an inotropic score were tested, and maximum vasoactive-inotropic score in the first 24 hours was further analyzed for association with clinical outcomes. The primary composite "poor outcome" variable included at least one of mortality, mechanical circulatory support, cardiac arrest, renal replacement therapy, or neurologic injury. High vasoactive-inotropic score was empirically defined as more than or equal to 20. Multivariable logistic regression was performed controlling for center and patient characteristics. Patients with high vasoactive-inotropic score had significantly greater odds of a poor outcome (odds ratio, 6.5; 95% CI, 2.9-14.6), mortality (odds ratio, 13.2; 95% CI, 3.7-47.6), and prolonged time to first extubation and cardiac ICU length of stay compared with patients with low vasoactive-inotropic score. Stratified analyses by age (neonate vs infant) and surgical complexity (low vs high) showed similar associations with increased morbidity and mortality for patients with high vasoactive-inotropic score. CONCLUSIONS Maximum vasoactive-inotropic score calculated in the first 24 hours after cardiac ICU admission was strongly and significantly associated with morbidity and mortality in this multi-institutional cohort of infants undergoing cardiac surgery. Maximum vasoactive-inotropic score more than or equal to 20 predicts an increased likelihood of a poor composite clinical outcome. The findings were consistent in stratified analyses by age and surgical complexity.
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Shimazaki J, Motohashi G, Nishida K, Ubukata H, Tabuchi T. Postoperative arterial blood lactate level as a mortality marker in patients with colorectal perforation. Int J Colorectal Dis 2014; 29:51-5. [PMID: 23846515 PMCID: PMC3898377 DOI: 10.1007/s00384-013-1738-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aims to assess the clinical relevance of postoperative arterial blood lactate (LAC) level as a prognostic factor in patients with colorectal perforation. METHODS Forty-two patients (22 males, 20 females; mean age, 70.8 years) underwent emergency surgery for colorectal perforation. The patients were divided into mortality and survivor groups. As a prognostic scoring system, Acute Physiological and Chronic Health Evaluation II (APACHE-II), Sequential Organ Failure Assessment (SOFA), and Systemic Inflammatory Response Syndrome criteria were calculated. These scores, postoperative LAC level, and other data, including site and etiology of perforation, elapsed time from onset to surgery (eTIME), preoperative white blood cell (WBC) and platelet counts, preoperative C-reactive protein (CRP), and preoperative arterial blood base excess were assessed between the groups. RESULTS The total mortality rate was 33.3 %. On univariate analysis, the APACHE-II and SOFA scores were significantly higher, and eTIME was significantly longer in the mortality group than in the survivor group. The postoperative LAC level was significantly higher in the mortality group (43.1 ± 14.1 mg/dl) than in the survivor group (23.8 ± 12.7 mg/dl; p < 0.001), and the preoperative WBC was significantly lower in the mortality group than in the survivor group. Multivariate logistic regression analysis using the mortality risk factors determined by univariate analysis (eTIME, APACHE-II score, SOFA score, preoperative WBC count, and postoperative LAC) demonstrated that postoperative LAC level was an independent risk factor for mortality. CONCLUSIONS High postoperative LAC level was a useful factor for predicting high mortality rate in patients with colorectal perforation.
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Affiliation(s)
- Jiro Shimazaki
- Department of Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1, Chuo Ami-Machi, Inasiki-Gun, Ibaraki 300-0395 Japan
| | - Gyo Motohashi
- Department of Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1, Chuo Ami-Machi, Inasiki-Gun, Ibaraki 300-0395 Japan
| | - Kiyotaka Nishida
- Department of Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1, Chuo Ami-Machi, Inasiki-Gun, Ibaraki 300-0395 Japan
| | - Hideyuki Ubukata
- Department of Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1, Chuo Ami-Machi, Inasiki-Gun, Ibaraki 300-0395 Japan
| | - Takafumi Tabuchi
- Department of Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1, Chuo Ami-Machi, Inasiki-Gun, Ibaraki 300-0395 Japan
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Rey C, García-Hernández I, Concha A, Martínez-Camblor P, Botrán M, Medina A, Prieto B, López-Herce J. Pro-adrenomedullin, pro-endothelin-1, procalcitonin, C-reactive protein and mortality risk in critically ill children: a prospective study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R240. [PMID: 24131732 PMCID: PMC3840693 DOI: 10.1186/cc13064] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 09/17/2013] [Indexed: 02/07/2023]
Abstract
Introduction We tested the hypothesis that higher mid-regional pro-adrenomedullin (MR-proADM), carboxy-terminal pro-endothelin-1 (CT-proET-1), procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations would be associated with increased prediction of mortality risk scores. Methods Prospective observational study set in two pediatric intensive care units (PICUs). Two-hundred-thirty-eight patients were included. MR-proADM, CT-proET-1, PCT and CRP levels were compared between children with PRISM III and PIM 2 > p75 (Group A; n = 33) and the rest (Group B; n = 205). Results Median (range) MR-proADM levels were 1.39 nmol/L (0.52–12.67) in group A versus 0.54 (0.15–3.85) in group B (P < 0.001). CT-proET-1 levels were 172 pmol/L (27–500) versus 58 (4–447) (P < 0.001). PCT levels were 7.77 ng/mL (0.34–552.00) versus 0.28 (0.02–107.00) (P < 0.001). CRP levels were 6.23 mg/dL (0.08-28.25) versus 1.30 mg/dL (0.00-42.09) (P = 0.210). The area under the ROC curve (AUC) for the differentiation of group A and B was 0.87 (95% CI:0.81–0.821) for MR-proADM, 0.86 (95% CI:0.79–0.92) for CT-proET-1 and 0.84 (95% CI:0.74–0.94) for PCT. A MR-proADM > 0.79 nmol/L had 93% sensitivity and 76% specificity to differentiate groups, whereas a CT-proET-1 > 123 pmol/L had 77% sensitivity and 84% specificity, and a PCT concentration > 2.05 ng/mL had 80% sensitivity and specificity. Conclusions In critically ill children, high levels of MR-proADM, CT-proET-1 and PCT were associated with increased prediction of mortality risk scores. MR-proADM, CT-proET-1 and PCT concentrations higher than 0.80 nmol/L, 123 pmol/L and 2 ng/mL, respectively, could be used by clinicians to identify critically ill children at higher prediction of risk death scores.
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Buijs EAB, Zwiers AJM, Ista E, Tibboel D, de Wildt SN. Biomarkers and clinical tools in critically ill children: are we heading toward tailored drug therapy? Biomark Med 2012; 6:239-57. [PMID: 22731898 DOI: 10.2217/bmm.12.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In pediatric critical care, validated biomarkers are essential for guiding drug therapy. The aim of this article is to present examples of current biomarker developments in its full breadth, including biochemical substances, physiological measurements and clinical scoring tools, with a focus on the field of circulatory, renal and neurophysiologic failure. Within each field we consecutively discuss the rationale for the selected biomarkers, studies in critically ill children, biomarker validation stage and biomarker use or potential use in drug studies and clinical drug dosing. This article demonstrates that there is paucity of properly validated biomarkers. Nevertheless, recent developments in, for instance, the field of sepsis, point us toward a future wherein, for critically ill children, drug therapy may be personalized using proteomic profiling instead of a small number of biomarkers, in order to establish a personal and dynamic disease profile.
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Affiliation(s)
- Erik A B Buijs
- Intensive Care & Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Lindsay AJ, Xu M, Sessler DI, Blackstone EH, Bashour CA. Lactate clearance time and concentration linked to morbidity and death in cardiac surgical patients. Ann Thorac Surg 2012; 95:486-92. [PMID: 22959571 DOI: 10.1016/j.athoracsur.2012.07.020] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 07/05/2012] [Accepted: 07/10/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early predictors of morbidity after cardiac operations are lacking. Elevated lactate concentrations in the immediate postoperative period reflect unmet metabolic demand and may be associated with outcome. This study examined the association between early plasma lactate concentrations and outcome after cardiac operations. METHODS As a retrospective cohort investigation, patient information was obtained from the Cardiovascular Information and the Anesthesiology Institute's patient registries. Inclusion criteria were all adult cardiac surgical patients undergoing isolated coronary artery bypass grafting or valve procedures, or coronary artery bypass grafting with a valve procedure, from January 1, 2008, to August 7, 2008 (arterial lactate values were added to the patient registry beginning January 1, 2008). RESULTS Lactate concentrations during the initial 12 postoperative hours of a patient's stay in the cardiovascular intensive care unit were averaged (mean lactate concentration), and linear regression concentrations over time were used to predict when the lactate concentration would reach 1.5 mmol/L in individual patients (predicted lactate clearance time). We also considered the product of the mean and clearance (product value). Predicted lactate clearance time, mean lactate concentration, and product value were associated with any type of reoperation, death, and a set of composite outcomes (p < 0.001 for each). The accuracy of these indices was moderate to good, with the highest C statistic (for product value) being 0.82. CONCLUSIONS Predicted lactate clearance time, mean lactate concentration, and product value are each associated with death, any type of reoperation, and a set of composite outcomes in patients undergoing coronary artery bypass grafting or valve operations, or both. Product value provided the best early prognostic guidance in individual patients.
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Affiliation(s)
- Aaron J Lindsay
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio 44195, USA
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Maher AD, Coles C, White J, Bateman JF, Fuller ES, Burkhardt D, Little CB, Cake M, Read R, McDonagh MB, Rochfort SJ. 1H NMR spectroscopy of serum reveals unique metabolic fingerprints associated with subtypes of surgically induced osteoarthritis in sheep. J Proteome Res 2012; 11:4261-8. [PMID: 22784358 DOI: 10.1021/pr300368h] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Osteoarthritis (OA) is a highly prevalent joint disease. Its slow progressive nature and the correlation between pathological changes and clinical symptoms mean that OA is often well advanced by the time of diagnosis. In the absence of any specific pharmacological treatments, there is a pressing need to develop robust biomarkers for OA. We have adopted a nuclear magnetic resonance (NMR)-based metabolomic strategy to identify molecular responses to surgically induced OA in an animal model. Sheep underwent one of three types of surgical procedure (sham (control), meniscal destabilization, MD or anterior cruciate ligament transaction, ACLT), and for every animal a serum sample was collected both pre- and postoperatively, thus, affording two types of "control" data for comparison. 1D 1H NMR spectra were acquired from each sample at 800 MHz and the digitized spectral data were analyzed using principal components analysis and partial least-squares regression discriminant analysis. Our approach, combined with the study design, allowed us to separate the metabolic responses to surgical intervention from those associated with OA. We were able to identify dimethyl sulfone (DMSO2) as being increased in MD after 4 weeks, while ACLT-induced OA exhibited increased 3-methylhistidine and decreased branched chain amino acids (BCAAs). The findings are discussed in the context of interpretation of metabolomic results in studies of human disease, and the selection of appropriate "control" data sets.
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Affiliation(s)
- Anthony D Maher
- Discovery Technologies, Biosciences Research Division, Department of Primary Industries, Bundoora 3086, Victoria, Australia.
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Mehta NM, Costello JM, Bechard LJ, Johnson VM, Zurakowski D, McGowan FX, Laussen PC, Duggan CP. Resting energy expenditure after Fontan surgery in children with single-ventricle heart defects. JPEN J Parenter Enteral Nutr 2012; 36:685-92. [PMID: 22539159 DOI: 10.1177/0148607112445581] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on resting energy expenditure (REE) and oxygen consumption (VO(2)) after pediatric cardiopulmonary bypass (CPB) will facilitate optimal nutrient prescription. METHODS The authors measured continuous REE and VO(2), using an in-line indirect calorimetery (IC) in 30 consecutive children with single-ventricle physiology immediately after Fontan surgery. REE during steady state at 8 hours after surgery was compared with standard equation-estimated energy expenditure (EEE). Patients were classified into 3 groups: hypermetabolic (measured REE [MREE]/EEE ratio >1.2), hypometabolic (MREE/EEE ratio <0.8), and normometabolic (MREE/EEE ratio 0.8-1.2). Demographic, anthropometric, and perioperative clinical characteristics were examined for their correlation with metabolic status. RESULTS In 26 of 30 patients with completed IC, mean REE at 8 hours after surgery was 57 ± 20 kcal/kg/d, and mean VO(2) was 110 ± 35 mL/min. Mean values of VO(2) and REE did not change within the first 24 hours after surgery. There was poor correlation between MREE at 8 hours and the EEE using the World Health Organization equation (r = 0.32, P = .11). Most patients (n = 19, 73%) were either normometabolic or hypometabolic. Lack of hypermetabolism was significantly associated with higher intraoperative serum lactate level and positive fluid balance compared with the rest of the group. CONCLUSIONS The authors report a low prevalence of hypermetabolism in children with single-ventricle defects after Fontan surgery. Measured REE had poor correlation with equation-estimated energy expenditure in a majority of the cohort. The absence of increased energy expenditure after CPB will influence energy prescription in this group.
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Affiliation(s)
- Nilesh M Mehta
- Division of Critical Care Medicine/Anesthesia, Department of Anesthesiology, Pain and Perioperative Medicine, Children's Hospital Boston, Harvard Medical School, Bader 634, MSICU Office, 300 Longwood Ave, Boston, MA 02115, USA.
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Dodge-Khatami J, Gottschalk U, Eulenburg C, Wendt U, Schnegg C, Rebel M, Reichenspurner H, Dodge-Khatami A. Prognostic Value of Perioperative Near-Infrared Spectroscopy During Neonatal and Infant Congenital Heart Surgery for Adverse In-Hospital Clinical Events. World J Pediatr Congenit Heart Surg 2012; 3:221-8. [DOI: 10.1177/2150135111426298] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Perioperative monitoring with multisite near-infrared spectroscopy (NIRS) for congenital cardiac surgery with cardiopulmonary bypass may aid in predicting adverse clinical outcomes. Methods: Forty-one consecutive neonates and infants undergoing bypass were monitored with right + left cerebral and renal NIRS. Near-infrared spectroscopy and lactate were measured at 20 time points, from baseline 1 day preoperatively, during bypass and modified ultrafiltration (MUF; 10 minutes), until 24 hours postoperatively. Adverse events were extracorporeal membrane oxygenation (ECMO)/death, prolonged intensive care unit (ICU) or length of hospital stay. Results: Perioperative mean renal NIRS remained higher than baseline (n = 41) as did cerebral NIRS in all undergoing biventricular repair. During bypass (n = 41), mean right and left cerebral NIRS were equal. During MUF, cerebral and renal NIRS values increased ( P < .001). Cerebral NIRS and lactate inversely correlated during the first six postoperative hours. Extracorporeal membrane oxygenation /death occurred in four patients, correlating with cerebral and renal NIRS below 45% ( P = .030) and 40% ( P = .019) at anytime, respectively, and with mean lactate levels >9.3 mmol/L in the first postoperative 24 hours ( P < .001). Among survivors, renal NIRS below 30% at any time predicted a longer ICU stay. Conclusions: At bypass conclusion, 10 minutes of MUF does not adversely affect cerebral or renal NIRS. Left and right cerebral NIRS are equal, so that biparietal cerebral NIRS monitoring is probably not warranted. Perioperative cerebral and renal NIRS readings, respectively, below 45% and 40% correlate with ECMO/death and renal NIRS below 30% with prolonged ICU stay. Cerebral NIRS and lactate levels showed a strong inverse correlation during the first six postoperative hours.
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Affiliation(s)
- Jannika Dodge-Khatami
- Division of Congenital Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Urda Gottschalk
- Division of Pediatric Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Eulenburg
- Institute of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike Wendt
- Division of Pediatric Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Clivia Schnegg
- Division of Pediatric Cardiology, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Marcus Rebel
- Division of Congenital Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Division of Congenital Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Ali Dodge-Khatami
- Division of Congenital Cardiovascular Surgery, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Comparison of maximum vasoactive inotropic score and low cardiac output syndrome as markers of early postoperative outcomes after neonatal cardiac surgery. Pediatr Cardiol 2012; 33:633-8. [PMID: 22349666 PMCID: PMC3989285 DOI: 10.1007/s00246-012-0193-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 11/22/2011] [Indexed: 10/14/2022]
Abstract
Low cardiac output syndrome (LCOS) and maximum vasoactive inotropic score (VIS) have been used as surrogate markers for early postoperative outcomes in pediatric cardiac surgery. The objective of this study was to determine the associations between LCOS and maximum VIS with clinical outcomes in neonatal cardiac surgery. This was a secondary retrospective analysis of a prospective randomized trial, and the setting was a pediatric cardiac intensive care unit in a tertiary care children's hospital. Neonates (n = 76) undergoing corrective or palliative cardiac operations requiring cardiopulmonary bypass were prospectively enrolled. LCOS was defined by a standardized clinical criteria. VIS values were calculated by a standard formula during the first 36 postoperative hours, and the maximum score was recorded. Postoperative outcomes included hospital mortality, duration of mechanical ventilation, intensive care unit (ICU) and hospital lengths of stay (LOS), as well as total hospital charges. At surgery, the median age was 7 days and weight was 3.2 kg. LCOS occurred in 32 of 76 (42%) subjects. Median maximum VIS was 15 (range 5-33). LCOS was not associated with duration of mechanical ventilation, ICU LOS, hospital LOS, and hospital charges. Greater VIS was moderately associated with a longer duration of mechanical ventilation (p = 0.001, r = 0.36), longer ICU LOS (p = 0.02, r = 0.27), and greater total hospital costs (p = 0.05, r = 0.22) but not hospital LOS (p = 0.52). LCOS was not associated with early postoperative outcomes. Maximum VIS has only modest correlation with duration of mechanical ventilation, ICU LOS, and total hospital charges.
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MAARSLET L, MØLLER MB, DALL R, HJORTHOLM K, RAVN H. Lactate levels predict mortality and need for peritoneal dialysis in children undergoing congenital heart surgery. Acta Anaesthesiol Scand 2012; 56:459-64. [PMID: 22150620 DOI: 10.1111/j.1399-6576.2011.02588.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of this study was to investigate whether an initial post-operative lactate level is a predictor of mortality, need for peritoneal dialysis (PD), duration of intubation or length of stay (LOS) in the intensive care unit (ICU) in children undergoing cardiac surgery. METHOD A retrospective, observational follow-up study was conducted in 206 children undergoing cardiac surgery from 2006 to 2007. Multivariate logistics regression analyses were performed to determine whether the lactate level was an independent risk factor. The lactate concentration at arrival in the ICU, outcome and risk factors (patient demographics, surgical complexity, duration of cardiopulmonary bypass and inotropic score) were obtained from the electronic patient data management program and medical records. RESULT The median (interquartile range) lactate level was 1.9 mmol/l (1.3-2.7) in children immediately after cardiac surgery and a mortality of 3.9%. Eight percent of the children had a lactate level higher than 4.5 mmol/l. An increased lactate level ≥4.5 mmol/l resulted in an odds ratio (95% confidence intervals) of 8.4 (1.5-46.1) for mortality and an odds ratio of 16.9 (2.7-106.8) for PD after adjusting for Risk Adjustment for Congenital Heart Surgery 1. Because of the low number of deaths, limited confounder analysis was performed. Duration of intubation and LOS in the ICU were not associated with the initial lactate level when adjusting for confounders. CONCLUSION The initial post-operative lactate level was a predictor of mortality and need for PD in children undergoing surgery for congenital heart disease.
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Affiliation(s)
- L. MAARSLET
- Department of Anaesthesia and Intensive Care; Aarhus University Hospital; Aarhus; Denmark
| | - M. B. MØLLER
- Department of Anaesthesia and Intensive Care; Aarhus University Hospital; Aarhus; Denmark
| | - R. DALL
- Department of Anaesthesia and Intensive Care; Aarhus University Hospital; Aarhus; Denmark
| | - K. HJORTHOLM
- Department of Anaesthesia and Intensive Care; Aarhus University Hospital; Aarhus; Denmark
| | - H. RAVN
- Department of Anaesthesia and Intensive Care; Aarhus University Hospital; Aarhus; Denmark
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Sanchez PG, Bittle GJ, Burdorf L, Pierson RN, Griffith BP. State of Art: Clinical ex vivo lung perfusion: Rationale, current status, and future directions. J Heart Lung Transplant 2012; 31:339-48. [DOI: 10.1016/j.healun.2012.01.866] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2011] [Revised: 12/30/2011] [Accepted: 01/17/2012] [Indexed: 01/08/2023] Open
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Chasovskyi K, Fedevych O, Vorobiova G, Zhovnir V, Maksimenko A, Boychenko O, Lysak Y, Cohen G, Yemets I. Arterial switch operation in the first hours of life using autologous umbilical cord blood. Ann Thorac Surg 2012; 93:1571-6. [PMID: 22459547 DOI: 10.1016/j.athoracsur.2012.01.104] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 01/23/2012] [Accepted: 01/31/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND In this study, we analyzed our clinical experience performing the arterial switch operation in the first hours of life using autologous umbilical cord blood transfusion (AUCBT). The safety and efficiency of AUCBT was assessed and compared with surgery with the use of homologous blood transfusion. METHODS Between September 2009 and February 2011, 61 neonates underwent ASO at our institution. Patients were enrolled and allocated to two groups with different modalities of management strategies for neonates with dextrotransposition of the great arteries. RESULTS The groups were similar in diagnoses, birth weight, cardiopulmonary bypass protocol, and surgical technique, excepting timing of surgery and blood management strategy. Preoperative mean hematocrit did not differ significantly between the groups (45% versus 45%). Mean hematocrit was significantly lower in the study group than in the control group during cardiopulmonary bypass (24% versus 31%). The hematocrit progressively increased in the study group to 38% on the first postoperative day. Serum lactate levels were higher in the study group till the second day after surgery. There were no significant differences in postoperative clinical profiles. There were no hospital deaths and no AUCBT-related side effects in our study. CONCLUSIONS The arterial switch operation can be performed in the first hours of life with AUCBT. Therefore, AUCBT is a safe and an efficient alternative to homologous blood in neonatal open heart surgery. During the study, we also identified positive economic effects associated with this approach.
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Affiliation(s)
- Kyrylo Chasovskyi
- Department of Perfusiology, Ukrainian Children's Cardiac Center, Kyiv, Ukraine.
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Park SJ, Kim HS, Byon HJ, Kim CS, Cheong IY, Kim JT. Intraoperative Plasma Lactate as an Early Indicator of Major Postoperative Events in Pediatric Cardiac Patients. TOHOKU J EXP MED 2012; 228:239-45. [DOI: 10.1620/tjem.228.239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Seong-Joo Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital
| | - Hee-Soo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
| | - Hyo-Jin Byon
- Department of Anesthesiology and Pain Medicine, Inha National University Hospital
| | - Chong-Sung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
| | - Il-Young Cheong
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
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