title: Goal-directed medical therapy and point-of-care testing improve outcomes after congenital heart surgery.
abstract: OBJECTIVE
  A goal-directed therapy algorithm based on serial lactate values obtained from a point-of-care testing device was utilized in an attempt to reduce the mortality of patients after congenital heart surgery.
  
  
  METHODS
  Prospective study of patients undergoing surgery utilizing a goal-directed therapy algorithm in the postoperative period. The results of this group are compared with a historical cohort. Operative risk was determined using the RACHS-1 scoring system.
  
  
  METHODS
  A 12-bed cardiac intensive care unit (ICU) in a pediatric hospital.
  
  
  METHODS
  Patients undergoing surgery from July 2001 through September 2003 (group B, n=710) were compared to cohorts from June 1995 through June 2001 (group A, n=1,656). Group B patients were smaller and younger (median weight 6.2 vs 8 kg, p<0.001; median age 184 vs 327 days, p=0.004).
  
  
  METHODS
  Beginning in July 2001, blood lactate measurements were performed serially for 24 h after heart surgery. Based on lactate values and trends, therapy was amended.
  
  
  RESULTS
  Mortality was lower for group B (1.8 vs 3.7%, p=0.02). A reduction in mortality between group B and group A was noted in neonates (3.4 vs 12%, p=0.02), but not in older patients. Group B patients undergoing higher risk operations (Risk Adjustment for Congenital Heart Surgery-1 [RACHS-1] categories 3-6) had a significant reduction in mortality when compared to group A (3 vs 9%, p=0.006), no difference was noted in patients undergoing lower risk operations (RACHS-1 categories 1 and 2).
  
  
  CONCLUSIONS
  The combination of goal-directed therapy and point-of-care testing was associated with a marked decrease in mortality for patients undergoing congenital heart surgery. Improvement was greatest in the highest risk patients.
authors.affiliation: Cardiac Intensive Care Unit, Miami Children's Hospital, Suite 104, 3200 SW 60 Court, Miami, FL 33155, USA. anthony.rossi@mch.com
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Rossi
authors.forename: Danyal M
authors.initials: DM
authors.lastname: Khan
authors.forename: Robert
authors.initials: R
authors.lastname: Hannan
authors.forename: Juan
authors.initials: J
authors.lastname: Bolivar
authors.forename: Michel
authors.initials: M
authors.lastname: Zaidenweber
authors.forename: Redmond
authors.initials: R
authors.lastname: Burke
mesh_terms: D000465:Algorithms; D006330:Heart Defects, Congenital / Q000601:surgery*; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood*; D019095:Point-of-Care Systems / Q000458:organization & administration*; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D019344:Lactic Acid