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Miami, FL, United States

Rossi A.F.,Cardiac Intensive Care Program | Checchia P.A.,Section of Critical Care Medicine | Lopez L.,Childrens Hospital at Montefiore | Seiden H.S.,Childrens Heart Center at Steven and Alexandra Cohen Childrens Medical Center | Burke R.P.,Cardiac Intensive Care Program
Journal of Primary Care and Community Health | Year: 2012

Strategies for monitoring patients recovering after congenital heart surgery have evolved considerably as technology continues to progress. Monitoring techniques traditionally centered around the comprehensive physical examination have been replaced by a number of revolutionary technologies developed to objectively evaluate various components of the cardiovascular system. Despite scant evidence that these methodologies actually improve outcomes, some have been embraced by clinicians. We developed an Internet survey designed to describe current practices of clinicians who care for patients after congenital heart surgery. There were 162 respondents to our survey with the majority from the United States. The views of cardiologists, intensivists, those dual trained in both cardiology and critical care medicine, and surgeons are all robustly represented in the results. Serial lactate monitoring was the strategy that was utilized most often by respondents (94%), followed by multisite near-infrared spectrometry (NIRS, 67%). There were 78% who utilized the combination of serial lactate and NIRS monitoring. Serial lactate monitoring was the technique that was thought to best represent cardiovascular well-being after heart surgery (40%). The results of this survey suggest that despite the paucity of evidence that clinical outcomes of patients recovering after congenital heart surgery are improved by any of these monitoring techniques, there is almost universal acceptance to monitor patients with serial lactate monitoring, NIRS monitoring, or a combination of these techniques. © The Author(s) 2012.

Rossi A.F.,Cardiac Intensive Care Program | Lopez L.,Cardiac Intensive Care Program | Dobrolet N.,Cardiac Intensive Care Program | Khan D.,Cardiac Intensive Care Program | Bolivar J.,Cardiac Intensive Care Program
Neonatology | Year: 2010

Neonates with critical heart disease are at risk of significant deficiencies in systemic oxygen delivery. The incidence and clinical pattern of hyperlactatemia in neonates presenting with critical heart disease has not been described. We reviewed the lactate pattern of neonates transferred to our cardiac intensive care unit for surgical management of their heart disease over a 1-year period. Stabilization of these neonates began in the referring institutions. From 8/4/03 to 8/4/04, 75 neonates with critical heart disease were transferred to our unit for stabilization and subsequent surgery. Blood lactate was measured on admission and subsequently in any patient thought to be at risk of low systemic oxygen delivery. Lactate was measured in 59 patients on admission and in 63 patients within the first 48 h of admission. Median age on admission was 1 day (range 0-13). Median age at surgery was 8 days (range 1-30). Median length of stay was 20 days. Peak lactate was noted on admission in 51 patients, and at 12-24 h in 8 patients. Mild hyperlactatemia (2.3-5 mmol/l) was present in 30 patients on admission and moderate-to-severe hyperlactatemia (≥5 mmol/l) was present in 8 patients. Mean lactate level on admission was 3.1 ± 0.6 mmol/l, and this did not return to normal (<2.3 mmol/l) until 36 h after admission. Severe hyperlactatemia patients also were noted to have normal lactate levels by 36 h. The presence of hyperlactatemia did not affect length of stay or mortality. There were no preoperative deaths and 4 postoperative deaths (1 death in 38 patients with mild or severe hyperlactatemia). Hyperlactatemia is frequently present in neonates admitted to a tertiary care center for management of congenital heart disease. Blood lactate levels normalize within 36 h. The presence of preoperative hyperlactatemia, even when moderate-to-severe, does not have significant adverse effect on postoperative mortality. Copyright © 2010 S. Karger AG, Basel.

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