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Huang JS, Chen YK, Lin SH, Chen Q, Cao H, Zheng YR. A comparison of the changes in serum lactate between surgical repair and transthoracic device closure of ventricular septal defects in pediatric patients. Front Cardiovasc Med 2023; 9:961997. [PMID: 36684591 PMCID: PMC9849590 DOI: 10.3389/fcvm.2022.961997] [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: 06/05/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
Objective The purpose of this study was to compare the changes in serum lactate between surgical repair and transthoracic device closure of ventricular septal defects (VSDs) in pediatric patients. Methods This study was a retrospective analysis, and 314 pediatric patients with simple VSD from October 2019 to October 2021 were selected. The patients were divided into the S group (surgical repair) and the D group (transthoracic device closure). The serum lactate value at ICU admission and 6 h after operation, as well as the highest serum lactate value were collected, and the 6-h serum lactate clearance rate was calculated. Result Through propensity score matching, 43 pairs of cases were successfully matched. Compared with the S group, the D group had a shorter operation duration, ventilation duration, and ICU duration, as well as a lower drainage volume and total hospitalization cost. There was no significant difference between the two groups in the initial and highest serum lactate values after VSD closure, while the 6-h serum lactate value in the D group was significantly lower than that in the S group, and the 6-h serum lactate clearance rate in the D group was five times faster than that in the S group. In addition, the 6-h serum lactate clearance rate in the S group was mainly related to the operation time, CPB time, and ventilation time, while the 6-h serum lactate clearance rate in the D group was only related to the operation time. Conclusion The initial and highest serum lactate levels were not significantly different between surgical repair and transthoracic device closure of VSD, but the 6-h serum lactate clearance rate of device closure was five times faster than that of surgical repair.
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Ganushchak YM, Kurniawati ER, van der Horst IC, van Kuijk SM, Weerwind PW, Lorusso R, Maessen JG. Patterns of oxygen debt repayment in cardiogenic shock patients sustained with extracorporeal life support: A retrospective study. J Crit Care 2022; 71:154044. [DOI: 10.1016/j.jcrc.2022.154044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 03/04/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
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Hendrix RHJ, Ganushchak YM, Weerwind PW. Oxygen delivery, oxygen consumption and decreased kidney function after cardiopulmonary bypass. PLoS One 2019; 14:e0225541. [PMID: 31756180 PMCID: PMC6874338 DOI: 10.1371/journal.pone.0225541] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/05/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Low oxygen delivery during cardiopulmonary bypass is related to a range of adverse outcomes. Previous research specified certain critical oxygen delivery levels associated with acute kidney injury. However, a single universal critical oxygen delivery value is not sensible, as oxygen consumption has to be considered when determining critical delivery values. This study examined the associations between oxygen delivery and oxygen consumption and between oxygen delivery and kidney function in patients undergoing cardiopulmonary bypass. Methods Oxygen delivery, oxygen consumption and kidney function decrease were retrospectively studied in 65 adult patients. Results Mean oxygen consumption was 56 ± 8 ml/min/m2, mean oxygen delivery was 281 ± 39 ml/min/m2. Twenty-seven patients (42%) had an oxygen delivery lower than the previously mentioned critical value of 272 ml/min/m2. None of the patients developed acute kidney injury according to RIFLE criteria. However, in 10 patients (15%) a decrease in the estimated glomerular filtration rate of more than 10% was noted, which was not associated with oxygen delivery lower than 272 ml/min/m2. Eighteen patients had a strong correlation (r >0.500) between DO2 and VO2, but this was not related to low oxygen delivery. Central venous oxygen saturation (77 ± 3%), oxygen extraction ratio (21 ± 3%) and blood lactate levels at the end of surgery (1.2 ± 0.3 mmol/l) showed not to be indicative of insufficient oxygen delivery either. Conclusions This study could not confirm an evident correlation between O2 delivery and O2 consumption or kidney function decrease, even at values below previously specified critical levels. The variability in O2 consumption however, is an indication that every patient has individual O2 needs, advocating for an individualized O2 delivery goal.
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Affiliation(s)
- Rik H J Hendrix
- Department of Extra-Corporeal Circulation, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Yuri M Ganushchak
- Department of Extra-Corporeal Circulation, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Patrick W Weerwind
- Department of Extra-Corporeal Circulation, Maastricht University Medical Centre+, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
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Rubino AS, Torrisi S, Milazzo I, Fattouch K, Busà R, Mariani C, D’Aleo S, Giammona D, Sferrazzo C, Mignosa C. Designing a new scoring system (QualyP Score) correlating the management of cardiopulmonary bypass to postoperative outcomes. Perfusion 2014; 30:448-56. [DOI: 10.1177/0267659114557184] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Aim: The aim of this study was to ascertain if a score, directly derived from CPB records, could correlate to major postoperative outcomes. Methods: An additive score (QualyP Score) was created from 10 parameters: peak lactate value during CPB, peak VCO2i, lowest DO2i/VCO2i, peak respiratory quotient, CPB time, cross-clamp time, lowest CPB temperature, circulatory arrest, ultrafiltration during CPB, number of packed red cells transfused intraoperatively. The PerfSCORE was calculated, as well. Multivariable logistic regression models were built to detect the independent predictors of: peak lactate >3 mmol/L during the first three postoperative days; the incidence of acute kidney injury network (AKIN) 1-2-3; respiratory insufficiency; mortality. Results: The mean score was 4.8±2.6 (0-10). A QualyP Score ≥1 was predictive of postoperative acidosis (OR=1.595). A score ≥2 was predictive of AKIN 2 (OR=1.268) and respiratory insufficiency (OR=1.526). A score ≥5 was predictive of AKIN 3 (OR=1.848) and mortality (OR=1.497). Conclusions: QualyP Score may help to provide a quality marker of perfusion, emphasizing the need for goal-directed perfusion strategies.
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Affiliation(s)
- AS Rubino
- Cardiac Surgery Unit, A.O.U. “Policlinico-Vittorio Emanuele”, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - S Torrisi
- Perfusion Service, Cardiac Surgery Unit, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - I Milazzo
- Perfusion Service, Cardiac Surgery Unit, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - K Fattouch
- Cardiac Surgery Unit, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy
| | - R Busà
- Perfusion Service, Cardiac Surgery Unit, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - C Mariani
- Cardiac Surgery Unit, A.O.U. “Policlinico-Vittorio Emanuele”, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - S D’Aleo
- Cardiac Surgery Unit, A.O.U. “Policlinico-Vittorio Emanuele”, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - D Giammona
- Perfusion Service, Cardiac Surgery Unit, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - C Sferrazzo
- Perfusion Service, Cardiac Surgery Unit, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - C Mignosa
- Cardiac Surgery Unit, A.O.U. “Policlinico-Vittorio Emanuele”, Ferrarotto Hospital, University of Catania, Catania, Italy
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Slight RD, Alston RP, McClelland DB, Mankad PS. What Factors Should We Consider in Deciding When to Transfuse Patients Undergoing Elective Cardiac Surgery? Transfus Med Rev 2009; 23:42-54. [DOI: 10.1016/j.tmrv.2008.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Slight RD, Lux D, Nzewi OC, McClelland DB, Mankad PS. Oxygen Delivery and Hemoglobin Concentration in Cardiac Surgery: When Do We Have Enough? Artif Organs 2008; 32:949-55. [DOI: 10.1111/j.1525-1594.2008.00685.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Slight RD, O'Donohoe P, Fung AKY, Alonzi C, McClelland DBL, Mankad PS. Rationalizing blood transfusion in cardiac surgery: the impact of a red cell volume-based guideline on blood usage and clinical outcome. Vox Sang 2008; 95:205-10. [DOI: 10.1111/j.1423-0410.2008.01083.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hatherill M, Salie S, Waggie Z, Lawrenson J, Hewitson J, Reynolds L, Argent A. The lactate:pyruvate ratio following open cardiac surgery in children. Intensive Care Med 2007; 33:822-829. [PMID: 17377768 DOI: 10.1007/s00134-007-0593-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Accepted: 02/21/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To explore the relationship between lactate:pyruvate ratio, hyperlactataemia, metabolic acidosis, and morbidity. DESIGN AND SETTING Prospective observational study in the paediatric intensive care unit (PICU) of a university hospital. PATIENTS Ninety-seven children after open cardiac surgery. Most children (94%) fell into low-moderate operative risk categories; observed PICU mortality was 1%. INTERVENTIONS Blood was sampled on admission for acid-base analysis, lactate, and pyruvate. Metabolic acidosis was defined as standard bicarbonate lower than 22 mmol/l, raised lactate as higher than 2 mmol/l, and raised lactate:pyruvate ratio as higher than 20. MEASUREMENTS AND RESULTS Median cardiopulmonary bypass and aortic cross-clamp times were 80 and 46 min. Metabolic acidosis occurred in 74%, hyperlactataemia in 42%, and raised lactate:pyruvate ratio in 45% of children. In multivariate analysis lactate:pyruvate ratio increased by 6.4 in children receiving epinephrine infusion and by 0.4 per 10 min of aortic cross-clamp. Duration of inotropic support increased by 0.29 days, ventilatory support by 0.27 days, and PICU stay by 0.42 days, for each 1 mmol/l increase in lactate. Neither standard bicarbonate nor lactate:pyruvate ratio were independently associated with prolongation of PICU support. CONCLUSIONS Elevated lactate:pyruvate ratio was common in children with mild metabolic acidosis and low PICU mortality. Hyperlactataemia, but not elevated lactate:pyruvate ratio or metabolic acidosis, was associated with prolongation of PICU support. Routine measurement of lactate:pyruvate ratio is not warranted for children in low-moderate operative risk categories.
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Affiliation(s)
- Mark Hatherill
- Division of Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
| | - Shamiel Salie
- Division of Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Zainab Waggie
- Division of Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - John Lawrenson
- Division of Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - John Hewitson
- Division of Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Louis Reynolds
- Division of Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Argent
- Division of Critical Care and Children's Heart Disease, School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Slight RD, Bappu NJ, Nzewi OC, Lee RJ, McClelland DBL, Mankad PS. Factors predicting loss and gain of red cell volume in cardiac surgery patients. Transfus Med 2006; 16:169-75. [PMID: 16764595 DOI: 10.1111/j.1365-3148.2006.00663.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Haemoglobin may be a poor indicator of changes in red cell volume (RCV) because of factors such as haemodilution. This study has been designed to analyse what peri-operative variables may be associated with loss or gain in RCV due to bleeding or transfusion. Prospective observational study. Single centre study based in a regional cardiac surgery centre. Twenty-nine elective adult cardiac surgery patients. Loss and gain of RCV were measured in theatre and for the first 24 h post-operatively. Patient and operative factors analysed were age, sex, height, weight, body surface area (BSA), induction haematocrit (Hct), estimated pre-operative RCV and antiplatelet therapy taken less than 7 days before operation, cardiopulmonary bypass (CPB) time, aortic occlusion time, minimum and maximum CPB temperatures and fluid administered. Age, sex, height, weight, BSA and induction Hct were found to predict red cell transfusion but not RCV loss. The total number of red cells transfused was significantly associated with RCV lost when expressed as a percentage reduction in the estimated pre-operative RCV but not the absolute RCV lost. Pre-operative RCV, as predicted by the variables outlined above, is more important than RCV lost in triggering red cell transfusion.
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Affiliation(s)
- R D Slight
- Department of Cardiothoracic Surgery, The Royal Infirmary of Edinburgh, Little France Crescent, Old Dalkeith Road, Edinburgh, Scotland, UK.
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Slight RD, Bappu NJ, Nzewi OC, McClelland DBL, Mankad PS. Perioperative red cell, plasma, and blood volume change in patients undergoing cardiac surgery. Transfusion 2006; 46:392-7. [PMID: 16533281 DOI: 10.1111/j.1537-2995.2006.00734.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Current blood prescription in cardiac surgery is based largely on hemoglobin (Hb) concentration. Hb may not provide a reliable guide to the patient's red cell (RBC) volume (RCV) during cardiac surgery as a consequence of the high fluid loads infused. This study provides estimates of the perioperative changes in RCV, plasma volume (PV), and blood volume (BV) with a view to developing a more accurate way of assessing a patient's need for transfusion. STUDY DESIGN AND METHODS Thirty adult elective cardiac surgery patients were recruited to the study. The preoperative RCV was calculated by use of a standard nomogram. Losses and gains in RCV at several time points were added or subtracted from the baseline value. Estimates of PV and BV were derived from patient hematocrit level and RCV for each time point. RESULTS The greatest perioperative loss of RCV occurred during cardiopulmonary bypass (CPB); however, half of this loss was returned to the patient at the end of CPB. A net gain of RCV occurred during the period of intensive care management. PV and BV showed two distinct peaks, immediately after CPB and at 16 hours after intensive therapy unit return. CONCLUSIONS PV and BV expansion are significant factors that may lead to a Hb value that is misleadingly low in that it overestimates the decrease in RCV. This effect could lead to unnecessary transfusion if the RBC transfusion threshold is based only on Hb concentration.
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Affiliation(s)
- Robert D Slight
- Department of Cardiothoracic Surgery, The Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, Scotland, United Kingdom.
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Hatherill M, Salie S, Waggie Z, Lawrenson J, Hewitson J, Reynolds L, Argent A. Hyperchloraemic metabolic acidosis following open cardiac surgery. Arch Dis Child 2005; 90:1288-92. [PMID: 16159902 PMCID: PMC1720224 DOI: 10.1136/adc.2005.078006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To describe acid-base derangements in children following open cardiac surgery on cardiopulmonary bypass (CPB), using the Fencl-Stewart strong ion approach. METHODS Prospective observational study set in the paediatric intensive care unit (PICU) of a university children's hospital. Arterial blood gas parameters, serum electrolytes, strong ion difference, strong ion gap (SIG), and partitioned base excess (BE) were measured and calculated on admission to PICU. RESULTS A total of 97 children, median age 57 months (range 0.03-166), median weight 14 kg (range 2.1-50), were studied. Median CPB time was 80 minutes (range 17-232). Predicted mortality was 2% and there was a single non-survivor. These children showed mild metabolic acidosis (median standard bicarbonate 20.1 mmol/l, BE -5.1 mEq/l) characterised by hyperchloraemia (median corrected Cl 113 mmol/l), and hypoalbuminaemia (median albumin 30 g/l), but no significant excess unmeasured anions or cations (median SIG 0.7 mEq/l). The major determinants of the net BE were the chloride and albumin components (chloride effect -4.8 mEq/l, albumin effect +3.4 mEq/l). Metabolic acidosis occurred in 72 children (74%) but was not associated with increased morbidity. Hyperchloraemia was a causative factor in 53 children (74%) with metabolic acidosis. Three (4%) hyperchloraemic children required adrenaline for inotropic support, compared to eight children (28%) without hyperchloraemia. Hypoalbuminaemia was associated with longer duration of inotropic support and PICU stay. CONCLUSIONS In these children with low mortality following open cardiac surgery, hypoalbuminaemia and hyperchloraemia were the predominant acid-base abnormalities. Hyperchloraemia was associated with reduced requirement for adrenaline therapy. It is suggested that hyperchloraemic metabolic acidosis is a benign phenomenon that should not prompt escalation of haemodynamic support. By contrast, hypoalbuminaemia, an alkalinising force, was associated with prolonged requirement for intensive care.
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Affiliation(s)
- M Hatherill
- Division of Critical Care & Children's Heart Disease, School of Child & Adolescent Health, University of Cape Town, South Africa.
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