Related Experiment Video
Updated: Mar 17, 2026
How to Administer Near-Infrared Spectroscopy in Critically ill Neonates, Infants, and Children
Published on: August 19, 2020
Ketosis After Cardiopulmonary Bypass in Children Is Associated With an Inadequate Balance Between Oxygen Transport
Philippe Klee1, Delphine Arni, Sonja Saudan
11Service of Development and Growth, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland. 2Service of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland. 3Pediatric Anesthesia Unit, Department of Anesthesiology, University Hospital of Geneva, Geneva, Switzerland.
Insights
Hyperglycemia and ketosis are common in children after heart surgery. Insulin effectively corrected ketosis, suggesting a potential benefit for specific pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Pediatric cardiac surgery
- Metabolic disorders
Background:
- Hyperglycemia post-cardiac surgery in children is linked to adverse outcomes, but causality and tight glycemic control benefits remain unclear.
- Understanding the metabolic state of pediatric patients during and after cardiopulmonary bypass is crucial.
Purpose of the Study:
- To characterize the metabolic profile of children undergoing cardiac surgery with cardiopulmonary bypass.
- To identify pediatric patient subgroups who may benefit from insulin therapy.
Main Methods:
- Prospective observational study involving 96 children (6 months–16 years) undergoing cardiac surgery.
- Metabolic tests conducted at various time points: pre-anesthesia, post-cardiopulmonary bypass, and at 4, 12, and 24 hours post-PICU admission.
- Insulin initiated for blood glucose levels >12 mmol/L (216 mg/dL).
Main Results:
- A significant prevalence of ketosis was observed: 17.9% post-cardiopulmonary bypass and 31.2% at PICU admission.
- Younger age was an independent risk factor for ketosis.
- Ketosis at PICU admission correlated with increased arterial-venous oxygen saturation difference, indicating impaired oxygen balance.
- Insulin treatment effectively corrected ketosis within 4 hours.
Conclusions:
- Ketosis is prevalent in pediatric patients post-cardiac surgery, particularly in younger children.
- Ketosis is associated with impaired oxygen transport and consumption, suggesting a potential mechanism for worse outcomes.
- Insulin therapy shows promise in correcting ketosis, warranting further investigation in randomized controlled trials to confirm its impact on patient outcomes.
Objectives:
Hyperglycemia after cardiac surgery and cardiopulmonary bypass in children has been associated with worse outcome; however, causality has never been proven. Furthermore, the benefit of tight glycemic control is inconsistent. The purpose of this study was to describe the metabolic constellation of children before, during, and after cardiopulmonary bypass, in order to identify a subset of patients that might benefit from insulin treatment.
Design:
Prospective observational study, in which insulin treatment was initiated when postoperative blood glucose levels were more than 12 mmol/L (216 mg/dL).
Setting:
Tertiary PICU.
Patients:
Ninety-six patients 6 months to 16 years old undergoing cardiac surgery with cardiopulmonary bypass.
Interventions:
None.
Measurements And Main Results:
Metabolic tests were performed before anesthesia, at the end of cardiopulmonary bypass, at PICU admission, and 4 and 12 hours after PICU admission, as well as 4 hours after initiation of insulin treatment. Ketosis was present in 17.9% patients at the end of cardiopulmonary bypass and in 31.2% at PICU admission. Young age was an independent risk factor for this condition. Ketosis at PICU admission was an independent risk factor for an increased difference between arterial and venous oxygen saturation. Four hours after admission (p = 0.05). Insulin corrected ketosis within 4 hours.
Conclusions:
In this study, we found a high prevalence of ketosis at PICU admission, especially in young children. This was independently associated with an imbalance between oxygen transport and consumption and was corrected by insulin. These results set the basis for future randomized controlled trials, to test whether this subgroup of patients might benefit from increased glucose intake and insulin during surgery to avoid ketosis, as improving oxygen transport and consumption might improve patient outcome.
Related Concept Videos
01:30Acute Respiratory Failure-III
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:20Inborn Errors of Metabolism
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:27Oxygen Transport in the Blood