当前位置： SCI文献检索 > Congenital Heart Disease期刊下所有文献 > Metabolic Uncoupling Following Cardiopulmonary Bypass.

Metabolic Uncoupling Following Cardiopulmonary Bypass.

Abstract：

OBJECTIVE:The objective of this study was to characterize the natural history of metabolic uncoupling (type B hyperlactemia and hyperglycemia) following cardiopulmonary bypass (CPB), and to determine the impact of insulin therapy on time to lactate normalization in patients without low cardiac output. DESIGN:The design used was a retrospective cohort study. SETTING:The study was set in a pediatric cardiac intensive care unit in a tertiary-care urban children's hospital. PATIENTS:All patients were aged ≤21 years admitted between 2007 and 2013 following cardiac surgery involving CPB with empiric intraoperative corticosteroids. ELIGIBILITY CRITERIA:simultaneous hyperlactemia (≥3.5 mEq/L) and hyperglycemia (≥200 mg/dL) within 48 hours after bypass. EXCLUSION CRITERIA:Exclusion criteria were evidence of low cardiac output state, diabetes or postoperative steroid administration. INTERVENTIONS:Characteristics were compared between those treated with insulin and those who were not (controls). OUTCOME MEASURES:Outcome measures used were time from admission to onset of hyperglycemia and hyperlactemia and time to resolution. Clinical outcomes included duration of mechanical ventilation, length of stay, unplanned readmission/reoperation, hypoglycemia and death. RESULTS:Of the 1345 patients receiving CPB, 132 (9.8%) met inclusion criteria. Seventy-eight (59%) were treated with insulin, leaving 54 controls. Patient characteristics, surgical complexity and time to onset of hyperglycemia and hyperlactemia were similar between groups. The insulin group had a shorter duration of hyperglycemia. There was no significant difference between groups in time to lactate normalization, ventilator days, length of stay, readmission and reoperation rates. Hypoglycemia (<60 mg/dL) occurred in three patients. CONCLUSIONS:In children with metabolic uncoupling after CPB, insulin use did not shorten the time to lactate normalization or alter clinical outcomes. These findings suggest that type B hyperlactemia with hyperglycemia after CPB will resolve spontaneously and does not warrant specific treatment.

journal_name

Congenit Heart Dis

journal_title

Congenital heart disease

authors

Palermo RA,Palac HL,Wald EL,Wainwright MS,Costello JM,Eltayeb OM,Backer CL,Epting CL

doi

10.1111/chd.12285

subject

Has Abstract

pub_date

2015-11-01 00:00:00

pages

E250-7

issue

eissn

1747-079X

issn

1747-0803

journal_volume

pub_type

杂志文章

在线工具

Metabolic Uncoupling Following Cardiopulmonary Bypass.