title: Metabolic Uncoupling Following Cardiopulmonary Bypass.
abstract: OBJECTIVE
  The objective of this study was to characterize the natural history of metabolic uncoupling (type B hyperlactemia and hyperglycemia) following cardiopulmonary bypass (CPB), and to determine the impact of insulin therapy on time to lactate normalization in patients without low cardiac output.
  
  
  METHODS
  The design used was a retrospective cohort study.
  
  
  METHODS
  The study was set in a pediatric cardiac intensive care unit in a tertiary-care urban children's hospital.
  
  
  METHODS
  All patients were aged ≤21 years admitted between 2007 and 2013 following cardiac surgery involving CPB with empiric intraoperative corticosteroids.
  
  
  METHODS
  simultaneous hyperlactemia (≥3.5 mEq/L) and hyperglycemia (≥200 mg/dL) within 48 hours after bypass.
  
  
  METHODS
  Exclusion criteria were evidence of low cardiac output state, diabetes or postoperative steroid administration.
  
  
  METHODS
  Characteristics were compared between those treated with insulin and those who were not (controls).
  
  
  METHODS
  Outcome measures used were time from admission to onset of hyperglycemia and hyperlactemia and time to resolution. Clinical outcomes included duration of mechanical ventilation, length of stay, unplanned readmission/reoperation, hypoglycemia and death.
  
  
  RESULTS
  Of the 1345 patients receiving CPB, 132 (9.8%) met inclusion criteria. Seventy-eight (59%) were treated with insulin, leaving 54 controls. Patient characteristics, surgical complexity and time to onset of hyperglycemia and hyperlactemia were similar between groups. The insulin group had a shorter duration of hyperglycemia. There was no significant difference between groups in time to lactate normalization, ventilator days, length of stay, readmission and reoperation rates. Hypoglycemia (<60 mg/dL) occurred in three patients.
  
  
  CONCLUSIONS
  In children with metabolic uncoupling after CPB, insulin use did not shorten the time to lactate normalization or alter clinical outcomes. These findings suggest that type B hyperlactemia with hyperglycemia after CPB will resolve spontaneously and does not warrant specific treatment.
authors.affiliation: Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
authors.forename: Robert A
authors.identifier: http://orcid.org/0000-0001-9233-7871
authors.initials: RA
authors.lastname: Palermo
authors.affiliation: Department of Preventive Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Palac
authors.affiliation: Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Wald
authors.affiliation: Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wainwright
authors.affiliation: Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Costello
authors.affiliation: Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
authors.forename: Osama M
authors.initials: OM
authors.lastname: Eltayeb
authors.affiliation: Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA.
authors.forename: Carl L
authors.initials: CL
authors.lastname: Backer
authors.affiliation: 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.
authors.forename: Conrad L
authors.initials: CL
authors.lastname: Epting
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism*; D002303:Cardiac Output, Low / Q000097:blood / Q000503:physiopathology / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D065906:Hyperlactatemia / Q000097:blood / Q000188:drug therapy / Q000209:etiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D007328:Insulin / Q000627:therapeutic use*; D007773:Lactates / Q000097:blood*; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D007773:Lactates
keywords: Cardiopulmonary Bypass; Congenital Heart Defects; Hyperglycemia; Insulin; Lactate; Pediatric Intensive Care Unit