Lactate Levels During Cardiopulmonary Bypass in Pediatric Patients
Condition: Heart Defects, Congenital
MeSH terms: Heart Defects, Congenital; Congenital Abnormalities
Study type: Observational [Patient Registry]

Summary: 
      Many variables measured in critically ill patients have been used to estimate severity of
      disease, prognosticate morbidity and mortality, evaluate costs of treatment, and finally
      indicate specific treatment and monitor the adequacy of treatment and its timing. It is
      unlikely that one measurement can replace all of these, but in the remainder of this
      manuscript the investigators will show that lactate levels may come close. Although in our
      mind strongly linked to tissue hypoxia, lactate levels follow many more metabolic processes
      not related to tissue hypoxia and, therefore, subject to many disturbances found in various
      clinical situations
    

Detailed description: 
      Forty consecutive pediatric patients who required cardiopulmonary bypass for repair or
      palliation of complex congenital heart disease will be enrolled in this study. Patients for
      the study were selected by convenience sampling, without randomization or control of surgical
      procedure, conduct of anesthesia, or CPB management.

      Patients will be monitored intra-operatively using ECG, invasive and non-invasive blood
      pressure monitoring, pulse oximetry and capnography for determination of End Tidal Co2 (
      ETCo2 ) and nasopharyngeal temperature. After induction of anesthesia and placement of an
      intra-arterial catheter 1 ml of arterial blood will collected into a heparinized 3 ml blood
      gas syringe and immediately analyzed on the arterial blood gas analyzer (GEM Premier 3000)
      for blood gas, hematocrit, electrolytes, calcium and glucose. Management strategy of
      cardio-pulmonary bypass (CPB) was standardized for all the patients. Lactate samples will
      drawn at specific time points within 5 time intervals: before CPB after induction, during
      cooling on CPB, during rewarming on CPB, immediately after CPB in the operating room, and
      after admission to the post-operative intensive care unit.

      Differences in lactate levels related to diagnosis will examined. To examine the effect of
      patient diagnosis and surgical risk on serum lactate level and outcome, the investigators
      separated patients into surgical risk categories Risk adjustment for congenital heart surgery
      (RACHS-1). This classification does not include heart transplantation. Patient mortality and
      the prevalence of postoperative complications for each of the 3 surgical risk categories
      relative to the change in lactate will examined.
    

Intervention name(s): Lactate
Intervention type(s): Other
Intervention description(s): Lactate samples will drawn at specific time points within 5 time intervals: before CPB after induction, during cooling on CPB, during rewarming on CPB, immediately after CPB in the operating room, and after admission to the post-operative intensive care unit.
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        cardiac surgery for children with congenital heart defects
      
Keywords: Lactate; Congenital cardiac defect; CPB; Pediatric