The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors

ERDEM, Kemalettin; BOZOĞLAN, Orhan; Serhatlıoğlu, Faruk; ceyran, hakan; OĞUZ, SONAY

The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors

Sonay OĞUZ, (Sivas Anadolu Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Sivas, Türkiye)

Orhan BOZOĞLAN, (Sütçü İmam Üniversitesi, Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, Kahramanmaraş, Türkiye)

Faruk SERHATLIOĞLU, (Erciyes Üniversitesi, Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, Kayseri, Türkiye)

Kemalettin ERDEM, (Abant İzzet Baysal Üniversitesi, Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim Dalı, Bolu, Türkiye)

Hakan CEYRAN (Kartal Koşuyolu Kalp Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul, Türkiye)

Erciyes Tıp Dergisi

1 0

Yıl: 2014 Cilt: 36 Sayı: 1 Sayfa Aralığı: 24 - 28 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors

Öz:

Amaç: Bu çalışmada, pediatrik açık kalp cerrahisi uygulanan hastalarda hiperlaktatemi sıklığının olası risk faktörleri, postoperatif morbidite ve mortalite ile ilişkisi araştırıldı. Materyal ve Metot: Bu çalışma Ocak 2008 ve Temmuz 2008 arasında kardiyovasküler cerrahi kliniğinde hipotermik kardiyopulmoner baypas ile açık kalp ameliyatı geçirmiş 45 ardışık pediatrik hastayı kapsadı. Her hastadan laktat analizi için preoperatif, intraoperatif ve postoperatif 1. ve 12. saat olmak üzere dört kan örneği alındı. Hastalar laktat düzeylerine göre yüksek laktat grubu (ortalama laktat düzeyi ≥3 mmol/L) ve normal laktat grubu (ortalama laktat düzeyi <3 mmol/L) olarak iki gruba ayrıldı. Hiperlaktatemi sıklığı, ilişkili risk faktörleri ve morbidite ve mortalite ile ilişki istatistiksel olarak analiz edildi. Bulgular: 45 olgunun, 33ü (%73.3) normal laktat (NL) grubuna ve 12si (%26.7) yüksek laktat (HL) grubuna dahil edildi. HL grubunda laktat düzeyleri ile mortalite arasında sınırda bir ilişki bulundu (p=0.052). Vücut yüzey alanı, yaş, düşük kalp debisi sendromu, intraoperatif ve postoperatif inotropik destek gereksinimi, mekanik ventilasyon süresi mortalite ile ilişkili risk faktörleri olarak belirlendi (p<0.05). Düşük kalp debisi sendromu, idrar çıkışı ve metabolik asidoz hiperlaktatemi ile ilişkili risk faktörleri olarak belirlendi (p<0.05).Sonuç: Yoğun bakım ünitesinde takip edilen hastalarda, laktat konsantrasyonu hastalık şiddeti için iyi bir göstergedir. Kan laktat düzeyleri rutin takipte kullanılabilecek bir parametre gibi görünmektedir.

Anahtar Kelime:

Konular: Genel ve Dahili Tıp

Pediatrik Açık Kalp Cerrahisi Sonrası Hiperlaktateminin Mortalite, Morbidite ile İlişkisi ve Risk Faktörleri

Öz:

Objective: In this present study, the association of hyperlactatemia frequency with probable risk factors, postoperative morbidity and mortality were investigated in patients undergoing paediatric open heart surgery. Materials and Methods: The present study included 45 consecutive paediatric patients who had undergone open heart surgery with hypothermic cardiopulmonary bypass in the cardiovascular surgery clinic between January 2008 and July 2008. Four blood samples for lactate analysis were collected from each of the patients preoperatively, intraoperatively and at 1 and 12 hours post- operatively. The patients were divided into two groups according to blood lactate levels as the high lactate group (mean lactate level≥ 3 mmol/L) and the normal lactate group (mean lactate level <3 mmol/L). Hyperlactatemia frequency, associated risk factors, and the relationship with morbidity and mortality were statistically analysed. Results: Of 45 cases, 33 (73.3%) were included in the normal lactate (NL) group, and 12 (26.7%) were included in the high lactate (HL) group. A borderline association was found between lactate levels and mortality in the HL group (p=0.052). Body surface area, age, low cardiac output syndrome, intraoperative and postoperative inotropic support requirement, duration of mechanical ventilation were determined as risk factors associated with mortality (p<0.05), and low cardiac output syndrome, urine output and metabolic acidosis were determined as risk factors associated with hyperlactatemia (p<0.05). Conclusion: In patients followed up in the intensive care unit, lactate concentration is a good indicator for disease severity. Blood lactate levels seems to be a parameter that can be used in routine follow-up.

Anahtar Kelime:

Konular: Genel ve Dahili Tıp

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Civetta JM, Taylor RW, Kirby RR, eds. Postoperative management of the adult cardiac surgery patient. Critical care. 3rd ed. Philadelhia, PA: Lippincott Williams & Wilkins, 1997.p.1147-75.
2. Vincent JL, Dufaye P, Berré J, Leeman M, Degaute JP, Kahn RJ. Serial lactate determinations during circulatory shock. Critical Care Med 1983; 11(6): 449-51. [CrossRef]
3. Bakker J, Coffernils M, Leon M, Gris P, Vincent JL. Blood lactate levels are superior to oxygen derived variables in predicting outcome in human septic shock. Chest 1991; 99(4): 956-62. [CrossRef]
4. Landow L. Splanchnic lactate production in cardiac surgery patients. Crit Care Med 1993; 21(2): 84-91. [CrossRef]
5. Ranucci M, De Toffol B, Isgrò G, Romitti F, Conti D, Vicentini M. Hy- perlactatemia during cardiopulmonary bypass: determinants and impact on postoperative outcome. Crit Care. 2006: 10(6): R167. [CrossRef]
6. Sheppard AP, Granger DN. Metabolic regulation of the intestinal circulation. In Sheppard A, Granger D, editors. Physiology of the intestinal circulation. New York: Raven Press; 1984.p.33-47.
7. Valenza F, Aletti G, Fossali T, Chevallard G, Sacconi F, Irace M, Gat- tinoni L. Lactate as a marker of energy failure in critically ill patients: hypothesis. Crit Care 2005; 9(6): 588-93. [CrossRef]
8. Basaran M, Sever K, Kafali E, Ugurlucan M, Sayin OA, Tansel T, et al. Serum Lactate Level Has Prognostic Significance After Pediatric Cardiac Surgery. J Cardiothorac Vasc Anesth 2006; 20(1): 43-7. [CrossRef]
9. Meregalli A, Oliveira RP, Friedman G. Occult hypoperfusion is asso- ciated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care 2004; 8(2): 60-5. [CrossRef]
10. Friedman G, Berlot G, Kahn RJ, Vincent JL. Combined mea- surements of blood lactate concentrations and gastric intramuco- 27 sal pH in patients with severe sepsis. Crit Care Med 1995; 23(7): 1184-93. [CrossRef]
11. Claridge JA, Crabtree TD, Pelletier SJ, Butler K, Sawyer RG, Young JS. Persistent occult hypoperfusion is associated with a significant increase in infection rate and mortality in major trauma patients. J Trauma 2000; 48(1): 8-14. [CrossRef]
12. Jeng JC, Jablonski K, Bridgeman A, Jordan MH. Serum lactate, not base deficit, rapidly predicts survival after major burns. Burns 2002; 28(2): 161-6. [CrossRef]
13. Mikulaschek A, Henry SM, Donovan R, Scalea TM. Serum lactate is not predicted by anion gap or base excess after trauma resuscitation. J Trauma 1996; 40(2): 218-22. [CrossRef]
14. Maillet JM, Le Besnerais P, Cantoni M, Nataf P, Ruffenach A, Lessana A, et al. Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery. Chest 2003; 123(5): 1361-6. [CrossRef]
15. Bolcal C, Doğancı S, Demirkılıç U, Tatar H. Koroner Bypass Cerrahisi Sonrası Görülen Hiperlaktateminin Sıklığı, Risk Faktörleri Ve Sonuçları. Turkiye Klinikleri J Cardiovasc Sci 2007; 19(1): 27-31.
16. Park SJ, Kim HS, Byon HJ, Kim CS, Cheong IY, Kim JT. Intraoperative plasma lactate as an early indicator of major postoperative events in pediatric cardiac patients. Tohoku J Exp Med 2012; 228(3): 239-45. [CrossRef]

APA	OĞUZ S, BOZOĞLAN O, Serhatlıoğlu F, ERDEM K, ceyran h (2014). The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors. , 24 - 28.
Chicago	OĞUZ SONAY,BOZOĞLAN Orhan,Serhatlıoğlu Faruk,ERDEM Kemalettin,ceyran hakan The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors. (2014): 24 - 28.
MLA	OĞUZ SONAY,BOZOĞLAN Orhan,Serhatlıoğlu Faruk,ERDEM Kemalettin,ceyran hakan The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors. , 2014, ss.24 - 28.
AMA	OĞUZ S,BOZOĞLAN O,Serhatlıoğlu F,ERDEM K,ceyran h The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors. . 2014; 24 - 28.
Vancouver	OĞUZ S,BOZOĞLAN O,Serhatlıoğlu F,ERDEM K,ceyran h The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors. . 2014; 24 - 28.
IEEE	OĞUZ S,BOZOĞLAN O,Serhatlıoğlu F,ERDEM K,ceyran h "The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors." , ss.24 - 28, 2014.
ISNAD	OĞUZ, SONAY vd. "The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors". (2014), 24-28.

APA	OĞUZ S, BOZOĞLAN O, Serhatlıoğlu F, ERDEM K, ceyran h (2014). The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors. Erciyes Tıp Dergisi, 36(1), 24 - 28.
Chicago	OĞUZ SONAY,BOZOĞLAN Orhan,Serhatlıoğlu Faruk,ERDEM Kemalettin,ceyran hakan The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors. Erciyes Tıp Dergisi 36, no.1 (2014): 24 - 28.
MLA	OĞUZ SONAY,BOZOĞLAN Orhan,Serhatlıoğlu Faruk,ERDEM Kemalettin,ceyran hakan The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors. Erciyes Tıp Dergisi, vol.36, no.1, 2014, ss.24 - 28.
AMA	OĞUZ S,BOZOĞLAN O,Serhatlıoğlu F,ERDEM K,ceyran h The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors. Erciyes Tıp Dergisi. 2014; 36(1): 24 - 28.
Vancouver	OĞUZ S,BOZOĞLAN O,Serhatlıoğlu F,ERDEM K,ceyran h The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors. Erciyes Tıp Dergisi. 2014; 36(1): 24 - 28.
IEEE	OĞUZ S,BOZOĞLAN O,Serhatlıoğlu F,ERDEM K,ceyran h "The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors." Erciyes Tıp Dergisi, 36, ss.24 - 28, 2014.
ISNAD	OĞUZ, SONAY vd. "The relationship of hyperlactatemia following paediatric open heart surgery with mortality, morbidity and risk factors". Erciyes Tıp Dergisi 36/1 (2014), 24-28.