G72 LATE ONSET HYPERLACTATAEMIA FOLLOWING PAEDIATRIC CARDIAC SURGERY

L. Jackman, N. Shetty, P. Davies, K. Morris.Birmingham Children’s Hospital, Birmingham, UK

Introduction: We have observed a number of children admitted after surgery with a normal lactate who develop late onset hyperlactatemia (>3 mmol/l) within the following 12 hours. We undertook this study to determine the incidence of and risk factors for late onset hyperlactatemia and whether this group of children have adverse clinical outcomes. We elected to study two cohorts of children, firstly a homogeneous group undergoing a single procedure, the Fontan operation, and secondly a more heterogeneous group of children undergoing a variety of procedures requiring CPB.

Methods: A retrospective study in the paediatric intensive care unit of a tertiary referral centre. Cohort 1: 64 patients undergoing a fenestrated Fontan procedure, mean (SD) age 5.4 (1.9) years. Cohort 2: 84 patients aged 3–16 years (mean 7.8 (3.8) years) undergoing mixed procedures. Operative details were recorded. Arterial blood gases together with lactate and glucose concentrations were recorded at 0, 4, 8, and 12 hours postoperatively. Corresponding hemodynamic variables and levels of inotropic, vasodilator support were collected. Cardiac output was not measured but indirect markers of systemic perfusion were recorded. Information relating to complications, length of mechanical ventilation, and length of PICU and hospital stay were collected. Data from the late onset hyperlactatemia group were compared with the group of children with a normal blood lactate concentration throughout (NOR) using parametric and non-parametric statistics as appropriate (MINITAB).

Results: Cohort 1: 28 patients (44%) developed late onset hyperlactatemia, 14 patients (22%) maintained a low lactate (NOR). A strong association was found between late onset hyperlactatemia and the development of hyperglycemia (p<0.001) and to a lesser extent with the use of epinephrine (p<0.03). Cohort 2: 23 patients (27%) developed late onset hyperlactatemia, 23 patients (27%) maintained a low lactate (NOR). Again …