| Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease. | |
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MedLine Citation:
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PMID: 10884658 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Neonates with congenital heart disease may appear hemodynamically stable after operation and then suddenly experience catastrophic decompensation. An improved means of predicting which infants will suddenly die in the early postoperative period may lead to lifesaving interventions. Studies indicate that blood lactate level is proportional to tissue oxygen debt, but information linking lactate levels with outcome in infants after operation is limited. We sought to determine whether a change in lactate level over time was predictive of a poor outcome defined as death within the first 72 hours or the need for extracorporeal membrane oxygenation. METHODS: To test this hypothesis, we studied prospectively 46 infants who were less than 1 month old and were undergoing complex cardiac surgical palliation or repair. Postoperative arterial oxygen saturation, bicarbonate, and lactate levels were recorded on admission to the intensive care unit and every 3 to 12 hours for the first 3 days. RESULTS: Thirty-seven patients had a good outcome, and 9 patients had a poor outcome. Mean initial lactate level was significantly greater in patients with a poor outcome (9.4 +/- 3.8 mmol/L) than in patients with a good outcome (5.6 +/- 2.1 mmol/L; P =.03). However, an elevated initial lactate level of more than 6 mmol/L had a low positive predictive value (38%) for poor outcome. In contrast, a change in lactate level of 0.75 mmol/L per hour or more was associated with a poor outcome (P <.0001) and predicted a poor outcome with an 89% sensitivity value, a 100% specificity value, and a 100% positive predictive value. CONCLUSIONS: Serial blood lactate level measurements may be an accurate predictor of death or the requirement for extracorporeal membrane oxygenator support for patients who undergo complex neonatal cardiac surgery. |
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Authors:
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J R Charpie; M K Dekeon; C S Goldberg; R S Mosca; E L Bove; T J Kulik |
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Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 120 ISSN: 0022-5223 ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2000 Jul |
Date Detail:
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Created Date: 2000-08-09 Completed Date: 2000-08-09 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 73-80 Citation Subset: AIM; IM |
Affiliation:
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University of Michigan Congenital Heart Center, University of Michigan Medical Center, Ann Arbor, MI 48109-0204, USA. jcharpie@umich.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Extracorporeal Membrane Oxygenation Heart Defects, Congenital / surgery*, therapy Humans Infant, Newborn Lactic Acid / blood* Palliative Care Predictive Value of Tests Prospective Studies Sensitivity and Specificity Time Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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50-21-5/Lactic Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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