• Amit Agrawal, Naresh Agrawal, Jyotirmay Das, and Amit Varma.
• Department of Pediatrics, Chirayu Medical College and Hospital, Bhopal, Madhya Pradesh, India.
• Indian J Crit Care Med. 2012 Oct 1; 16 (4): 193-7.

BackgroundPost-operative course after complex pediatric cardiac surgery is unpredictable. Although, change in arterial lactate levels has been used as a surrogate marker for many years, scientific evidence correlating the early perioperative lactate levels with outcome is still lacking.ObjectiveTo evaluate the trends in lactate levels from intraoperative period to an extended post-operative period in pediatric intensive care unit (PICU) and to assess its usefulness as a prognostic marker.DesignProspective observational study.SettingTertiary pediatric cardiac surgical unit.PatientsThirty-five non-consecutive children aged 1-140 months who underwent surgery for congenital heart diseases (CHD) on cardiopulmonary bypass (CPB).InterventionNone.Materials And MethodsARTERIAL BLOOD LACTATE LEVELS WERE OBTAINED AT THE FOLLOWING TIME POINTS: After induction of anesthesia, 15 and 45 min after institution of CPB, at the start of rewarming, after sternotomy closure, then at 1, 6, 24, and 48 h in PICU. Other hemodynamic and clinical variables, CPB variables, blood gas values, and laboratory variables were also recorded.ResultsFour patients died out of 35 patients (11.4%). Non-survivors showed significant persistent elevation in lactates (>4.0 mmol/l). Peak lactates correlate significantly with longer aortic cross clamp time, CPB duration, ventilation hours and PICU stay.ConclusionEarly point of care lactate can be a useful prognostic marker in post-cardiac surgery patients in adjunct with other parameters measured in PICU. This reiterates the importance of measuring lactates and timely recognition of at-risk patients, which on early intervention can help in reducing post-operative morbidity and mortality.

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