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Carbon dioxide production index (VCO2i) predicts hyperlactatemia during cardiopulmonary bypass in pediatric carDiac
Yan Zhang1, Hui Xiong1, Bo Wang1
1Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China.
Insights
This study investigates hyperlactatemia during cardiopulmonary bypass in infants. It aims to establish a critical threshold for carbon dioxide production index (VCO2i) to optimize pediatric cardiac surgery outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Physiology
Background:
- Hyperlactatemia (HL) is common in infants undergoing cardiopulmonary bypass (CPB), increasing morbidity and mortality.
- Adult studies link carbon dioxide production index (VCO2i) to HL during CPB, suggesting a threshold of 60 mL/min/m².
- Infants have higher metabolic rates and lower hypoxia tolerance, necessitating a distinct VCO2i threshold for pediatric CPB.
Purpose of the Study:
- To investigate the association between VCO2i during CPB and HL in infants.
- To determine the critical VCO2i threshold during CPB in pediatric patients.
- To inform goal-directed perfusion (GDP) strategies for improved outcomes in pediatric cardiac surgery.
Main Methods:
- Nested case-control study enrolling pediatric patients (<3 years) undergoing congenital cardiac surgery.
- Continuous monitoring and recording of VCO2i every 5 minutes during CPB.
- Analysis of pre- and intraoperative factors associated with HL and determination of critical VCO2i values.
Main Results:
- The study will identify the rate of HL in pediatric patients during CPB.
- It will establish a critical VCO2i threshold specific to infants undergoing CPB.
- Postoperative outcomes will be compared between infants with and without HL.
Conclusions:
- This study is the first to explore the critical VCO2i threshold for HL in pediatric CPB.
- Findings are expected to support the clinical application of GDP management strategies.
- Optimizing perfusion strategies based on VCO2i may improve prognosis for pediatric cardiac surgery patients.
Background:
Hyperlactatemia (HL) during cardiopulmonary bypass (CPB) is relatively frequent in infants and associates with increased morbidity and mortality. Studies on adults have shown that carbon dioxide production index (VCO2i) during CPB is linked to the occurrence of HL, with 'critical thresholds' for VCO2i reported to be 60 mL/min/m2. However, considering infants have a higher metabolic rate and lower tolerance to hypoxia, the critical threshold of VCO2i in infants cannot be replied to the existing adults' standards. The objective of this study is to investigate the association of VCO2i during CPB and HL, and explore the critical VCO2i threshold during CPB in infants.
Methods:
VCO2i predicts hyperlactatemia during cardiopulmonary bypass in pediatric cardiac surgery (pGDP-VCO2i) is a nested case-control study. A cohort of consecutive pediatric patients of less than 3 years of age, undergoing congenital cardiac surgeries between May 2021 and December 2023 in West China Hospital will be enrolled. The VCO2i levels of each patient will be recorded every 5 min during CPB. The primary outcome is the rate of HL. The infants will be divided into two groups based on the presence or not of HL. Pre- and intraoperative factors will be tested for independent association with HL. Then, we will make an analysis, and the critical value of VCO2i will be obtained. The postoperative outcome of patients with or without HL will be compared.
Discussion:
This will be the first trial to investigate the association of VCO2i during CPB and HL, and explore the critical VCO2i threshold during CPB in pediatrics. The results of this study are expected to lay a foundation for clinical application of goal-directed perfusion (GDP) management strategy, and optimize the perfusion strategy and improve the prognosis of pediatric patients undergoing cardiac surgery.
Trial Registration:
Chictr.org.cn, ChiCTR2100044296 on 16 March 2021.
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