Abstract
IntroductionCentral venous oxygen saturation and blood lactate are different indices of the adequacy of oxygen delivery to the oxygen needs. In pediatric cardiac surgery, lactate level and kinetics during and after cardiopulmonary bypass are associated with outcome variables. The aim of this study was to explore the hypothesis that the lowest central venous oxygen saturation and the peak lactate value during cardiopulmonary bypass, used alone or in combination, may be predictive of major morbidity and mortality in pediatric cardiac surgery.MethodsWe conducted a retrospective analysis of 256 pediatric (younger than 6 years) patients who had undergone cardiac surgery with continuous monitoring of central venous oxygen saturation and serial measurement of blood lactate.ResultsPeak lactate was significantly increased when the nadir central venous oxygen saturation was < 68%. Both nadir central venous oxygen saturation and peak lactate during cardiopulmonary bypass were independently associated with major morbidity and mortality, with the same accuracy for major morbidity and a higher accuracy of peak lactate for mortality. A combined index (central venous oxygen saturation < 68% and peak lactate > 3 mmol/L) provided the highest sensitivity and specificity for major morbidity, with a positive predictive value of 89%.ConclusionsThe combination of a continuous monitoring of central venous oxygen saturation and serial measurements of blood lactate during cardiopulmonary bypass may offer a predictive index for major morbidity after cardiac operations in pediatric patients. This study generates the hypothesis that strategies aimed to preserve oxygen delivery during cardiopulmonary bypass may reduce the occurrence of low values of central venous oxygen saturation and elevated lactate levels. Further studies should consider this hypothesis and take into account other time-related factors, such as time of exposure to low values of central venous oxygen saturation and kinetics of lactate formation.
Highlights
Central venous oxygen saturation and blood lactate are different indices of the adequacy of oxygen delivery to the oxygen needs
The present study investigates the hypothesis that simultaneous measurement of continuous central venous oxygen saturation (ScVO2) coupled with serial blood lactate determination may provide one or more early markers for postoperative adverse outcomes in pediatric cardiac surgery
In our series of 256 pediatric patients, this pattern was confirmed for ScVO2 values below 68%, with a significant increase of peak lactate during cardiopulmonary bypass (CPB), and may be interpreted as a condition of increased oxygen-extraction rate, insufficient to cover the oxygen consumption (VO2), with activation of anaerobic energy production
Summary
Central venous oxygen saturation and blood lactate are different indices of the adequacy of oxygen delivery to the oxygen needs. In pediatric patients undergoing cardiac surgery for congenital heart disease, many studies highlighted the potential role of hyperlactatemia on admission to the ICU as a marker for adverse outcome [10,11,12,13,14], and one study linked hyperlactatemia during CPB with postoperative morbidity and mortality [15]. Studies simultaneously addressing both ScVO2 and blood lactates during CPB as potential early predictors of morbidity and mortality in pediatric cardiac operations are still lacking
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