Background: Values of hyperlactatemia, hyperglycemia and acidosis in prediction of postoperative course after pediatric cardiac surgery are controversial.
Materials and methods: Between 2006 and 2008, eighty children (age range: 2 months-17 years) underwent cardiopulmonary bypass surgery. In all patients serum lactate, blood sugar and arterial blood gas parameters were measured 1(h1), 6(h6) and 12 hours (h12) after ICU entry. The measured values correlated with pump characteristics, occurrence of low cardiac output (LCO) state and death in the patients.
Results: Twenty one patients (26.3%) developed LCO state and four (5%) died. There was no difference between complicated and uncomplicated patients regarding to age, weight, pump time, type of prime solution and blood gas parameters. Blood sugar in h1 and serum lactate in h3 were significantly higher in complicated group (p= 0.008, 0.031). In dead group lower arterial pH (p= 0.008, 0.004), higher base deficit (0.021, 0.033) in h1 and h2, and higher blood sugar in h2 and h3 (p= 0.0001, 0.0001) were noted. Serum lactate above 3 mmol/L in h1 and h2 but not h3 were accompanied with longer bypass time (p= 0.0001, 0.012, 0.682 respectively). Logistic regression analysis showed that blood sugar above 157 mg/dl and serum lactate above 4.7 mmol/L were accompanied with adverse outcome.
Conclusion: In first 6 hours, blood sugar and arterial blood gas analysis were better predictors of adverse outcome after cardiopulmonary bypass surgery in pediatric age group. Serum lactate in early phase was correlated with bypass time and may be a late predictor of outcome.