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Intensive Care Medicine
Published in: Intensive Care Medicine 3/2009

01-03-2009 | Pediatric Original

Late-onset hyperlactataemia following paediatric cardiac surgery

Authors: Lara Jackman, Nayan Shetty, Paul Davies, Kevin P. Morris

Published in: Intensive Care Medicine | Issue 3/2009

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Abstract

Objective

To investigate the clinical significance of a late rise in blood lactate concentration, developing after PICU admission, in older children undergoing cardiac surgery.

Design

Retrospective, observational study.

Setting

Single UK PICU.

Patients and participants

A total of 147 children, aged 2–16 years, in 2 cohorts: FONTAN (n = 63) Fontan operation; and MIXED (n = 84) operations of varying complexity.

Interventions

None.

Measurements and results

Sequential data were collected up to 12 h postoperatively: arterial blood gas, lactate, glucose concentrations; haemodynamic variables; inotropic support; urine output, core-peripheral temperature gradient. Data were collected on clinical outcomes: PICU mortality; length of ventilation, PICU stay; renal and hepatic function. Late-onset hyperlactataemia (LOH) was defined if blood lactate increased to or above 3 mmol/l. Data from the LOH group were compared to a group with a low blood lactate (<3 mmol/l) throughout (No_LOH). LOH occurred in 28 (44%) and 21 (25%) of patients in FONTAN and MIXED cohorts, respectively. A strong association was found between LOH and hyperglycaemia (P < 0.001). No significant difference was found in postoperative urine output, core-peripheral temperature gradient or inotrope requirement in the LOH versus No_LOH groups. No significant differences were found with respect to clinical outcomes in the LOH versus No_LOH groups. All LOH patients were discharged from PICU within 1 day and survived.

Conclusions

LOH is common in older children following cardiac surgery. We found no evidence to suggest that it is associated with adverse clinical outcomes. The strong association between LOH and hyperglycaemia supports a metabolic aetiology.
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Metadata
Title
Late-onset hyperlactataemia following paediatric cardiac surgery
Authors
Lara Jackman
Nayan Shetty
Paul Davies
Kevin P. Morris
Publication date
01-03-2009
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 3/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-008-1331-1

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