Objectives: Predicting the postoperative course after complex pediatric cardiac surgery continues to be challenging. While lactate and its increase in arterial blood has been used as a surrogate marker for many years, we decided to look at the benefit of following the trends from Intraoperative period to an extended period in the ICU. Our intention was to see if this change would indicate prognosis for our patients.
Methods: 20 infants with congenital heart disease were included in this prospective study. The lactate levels were measured after induction of anaesthesia. 15 min and 45 min after institution of cardiopulmonary bypass. Lactate levels were also monitored sequentially 2 hours, 24 hours and 48 hours after reaching ICU . Other perioperative clinical variables such as urine output. duration of inotropes, ventilation hours and ICU stay were also recorded.
Results: Peak lactate levels during cardiopulmonary bypass correlates significantly with longer aortic cross clamp time, cardiopulmonary bypass time, prolonged ventilation hours and ICU stay. Decreasing trend in lactate levels were observed in ICU. 2 patients died out of 20 patients (10%). The patients who died had significant persistent elevation in lactate levels (more than 4.0 mmol/l).
Conclusions: Arterial blood lactate levels can be a useful adjuvant for prognosis of patients in adjunct with other parameters measured in ICU. This reiterates the importance of measuring lactate levels in ICU as a prognostic marker for postoperative morbidity and mortality.