Critical Care and Shock

Superior cava vein saturation and cardiac lactate as cardiac output predictor after cardio-pulmonary bypass on children

Objective: to evaluate cardiac heart lactate, superior cava vein saturation and microcirculation dysfunction as cardiac output predictors after surgery on patients with Tetralogy of Fallot (TF) through measuring serum level of sTNFR-1 and IL-6.
Design: cohort study
Setting: Cipto Mangunkusumo Hospital
Patient and participants: Subjects were children aged 1 to 6 years that underwent corrective surgery. Subjects who met the inclusion criteria were divided into 2 groups after ischemia-reperfusion injury (post surgery). The first group was subjects with high cardiac lactate and the second group was subjects with low cardiac lactate.
Measurements and results: Subjects were observed for 24 hours; during surgery, 6 and 24 hours after aortic clamp removed. During July 2012 – December 2013, there were 52 patients who became subjects. There were proportion differences between cardiac lactate and cardiac output change after cardiac surgery. Increase of cardiac lactate has a correlation with increasing levels of sTNFR-1 and IL-6 and decreasing index of Tc, ScvO2 and cardiac output. There were correlations among low index of ScvO2, high index of cardiac lactate and decrease of cardiac output. High sTNFR-1 and IL-6 were correlated to low cardiac output. Cardiac lactate, ScvO2 and MAP can be used as predictors of cardiac output change in patients with cardio-pulmonary bypass. sTNFR-1 and IL-6 levels were correlated with cardiac output changes after cardiac surgery.
Conclusion: Cardiac lactate and ScvO2 are valuable in measuring cardiac output changes on patient with cardio-pulmonary bypass.