title: Point of care serum lactate levels as a prognostic marker of outcome in complex pediatric cardiac surgery patients: Can we utilize it?
abstract: BACKGROUND
  Post-operative course after complex pediatric cardiac surgery is unpredictable. Although, change in arterial lactate levels has been used as a surrogate marker for many years, scientific evidence correlating the early perioperative lactate levels with outcome is still lacking.
  
  
  OBJECTIVE
  To evaluate the trends in lactate levels from intraoperative period to an extended post-operative period in pediatric intensive care unit (PICU) and to assess its usefulness as a prognostic marker.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Tertiary pediatric cardiac surgical unit.
  
  
  METHODS
  Thirty-five non-consecutive children aged 1-140 months who underwent surgery for congenital heart diseases (CHD) on cardiopulmonary bypass (CPB).
  
  
  METHODS
  None.
  
  
  METHODS
  ARTERIAL BLOOD LACTATE LEVELS WERE OBTAINED AT THE FOLLOWING TIME POINTS: After induction of anesthesia, 15 and 45 min after institution of CPB, at the start of rewarming, after sternotomy closure, then at 1, 6, 24, and 48 h in PICU. Other hemodynamic and clinical variables, CPB variables, blood gas values, and laboratory variables were also recorded.
  
  
  RESULTS
  Four patients died out of 35 patients (11.4%). Non-survivors showed significant persistent elevation in lactates (>4.0 mmol/l). Peak lactates correlate significantly with longer aortic cross clamp time, CPB duration, ventilation hours and PICU stay.
  
  
  CONCLUSIONS
  Early point of care lactate can be a useful prognostic marker in post-cardiac surgery patients in adjunct with other parameters measured in PICU. This reiterates the importance of measuring lactates and timely recognition of at-risk patients, which on early intervention can help in reducing post-operative morbidity and mortality.
authors.affiliation: Department of Pediatrics, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Agrawal
authors.forename: Naresh
authors.initials: N
authors.lastname: Agrawal
authors.forename: Jyotirmay
authors.initials: J
authors.lastname: Das
authors.forename: Amit
authors.initials: A
authors.lastname: Varma
keywords: Children; pediatric cardiac surgery; plasma lactate
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