Tissue microdialysis demonstrates that late-onset hyperlactataemia post-Fontan operation is mirrored by tissue lactate and pyruvate concentrations, and is not associated with tissue oxygen debt or low cardiac index.
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Post-Fontan hyperlactatemia may not indicate tissue hypoxia or low output; hypothesis-generating for non-ischemic mechanisms in single-ventricle patients.
We investigated tissue lactate, pyruvate and lactate:pyruvate (LP) ratio post cardiac surgery and the relationship of cardiac index and oxygen delivery to late onset hyperlactataemia in ICU. It involved a prospective study of 10 children, mean age 4.9 (0.4) years, post-Fontan operation admitted with normo-lactataemia. Tissue lactate, pyruvate and LP ratio were monitored postoperatively every 30 min for 12 h via subcutaneous microdialysis in the abdominal wall. Cardiac index was measured by PiCCO at 0, 4, 8 and 12 h. Blood and subcutaneous tissue lactate were strongly correlated (r=0.87; P=0.001). Mean (S.D.) blood lactate rose from 2.23 (0.49) to 3.73 (1.16) mmol l(-1) in the first 5 h after ICU admission (P=0.008), only one child remaining normal. Microdialysis revealed lactate rising from 3.8 (0.83) to 5.3 (1.6) (P=0.011), with a parallel pyruvate rise. LP ratio remained below 20, indicating no tissue oxygen debt. Cardiac index increased from 2.83 (0.63) to 3.77 (1.34) l min(-1) m(-2) over the same period (P=0.05), with a corresponding increase in oxygen delivery from 4556 (1094) to 6076 (2322) ml min(-1) (P=0.04). Tissue microdialysis provides near-continuous measurement of tissue lactate and pyruvate, post cardiac surgery. Blood lactate rise post-Fontan is mirrored by tissue lactate and pyruvate concentrations, and not associated with a low or falling cardiac index or with tissue oxygen debt.
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Hosein et al. (2008) studied this question.
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