Metabolic Uncoupling Following Cardiopulmonary Bypass

Robert A. Palermo, Hannah L. Palac, Eric L Wald, Mark S. Wainwright, John M. Costello, Osama Mohyeldin Eltayeb, Carl L Backer, Conrad L Epting*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

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 (<60mg/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.

Original languageEnglish (US)
Pages (from-to)E250-E257
JournalCongenital Heart Disease
Volume10
Issue number6
DOIs
StatePublished - Nov 1 2015

Keywords

  • Cardiopulmonary Bypass
  • Congenital Heart Defects
  • Hyperglycemia
  • Insulin
  • Lactate
  • Pediatric Intensive Care Unit

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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