RESUMEN
OBJECTIVES: To determine if a relationship exists between regional oxyhemoglobin saturation (rSO(2)) measured at various body locations by near-infrared spectroscopy (NIRS) and blood lactate level in children after cardiac surgery. DESIGN: A prospective, observational study. SETTING: A pediatric cardiac intensive care unit in a university hospital. PARTICIPANTS: Twenty-three children undergoing repair of congenital heart disease. Patients with single-ventricle physiology and/or residual intracardiac shunts were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Cerebral, splanchnic, renal, and muscle rSO(2) values were recorded every 30 seconds via NIRS for 24 hours postoperatively. Blood lactate levels measured minimally at 0, 2, 4, 6 and 24 hours postoperatively were correlated with rSO(2) values derived by averaging all values recorded during the 60 minutes preceding the blood draw. Twenty-three patients were enrolled with 163 lactate measurements and more than 39,000 rSO(2) observations analyzed. Cerebral rSO(2) had the strongest inverse correlation with lactate level followed by splanchnic, renal, and muscle rSO(2) (r = -0.74, p < 0.0001, r = -0.61, p < 0.0001, r = -0.57, p < 0.0001, and r = -0.48, p < 0.0001, respectively). The correlation improved by averaging the cerebral and renal rSO(2) values (r = -0.82, p < 0.0001). Furthermore, an averaged cerebral and renal rSO(2) value
Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Ácido Láctico/sangre , Complicaciones Posoperatorias/sangre , Espectroscopía Infrarroja Corta/métodos , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Complicaciones Posoperatorias/etiología , Valor Predictivo de las Pruebas , Estudios ProspectivosRESUMEN
Our policy of conducting biotransformation studies with extended chromatography prior to pharmacokinetic bioanalyses allowed us to quickly detect an unusual, cis/trans metabolite in rat plasma that was inseparable using a short chromatographic method. We caution investigators that short methods invite unknown isobaric metabolites to cause inaccuracies in plasma concentration measurements.