Journal Article

7970 Norwood surgery: etiometry, lactate and fluid balance

Sengupta Shahana, Ng, Cho, Saxena Rohit, Angadi Ullas, Kostolny Martin

2025

Overview

ObjectivesA retrospective analysis of relationship between pulse oximetry, lactate and fluid balance during first five post operative days and patient outcomes after Norwood stage 1MethodsA retrospective, single centre analysis of etiometric data during a 5 year period (Jan 2016- Dec 2020) was performed on children undergoing Norwood stage 1 procedure. SpO2 (minute by minute data), arterial lactate (229 total readings at various timepoints) and daily fluid balance was collected for the first five post operative days . The studied outcomes are listed in table 1.Results32 patients were identified. Four were excluded due to lack of access to etiometric data. Patient demography and surgical characteristics are demonstrated in table 1. Outcome parameters studied are demonstrated in table 2The ICU and hospital stays were higher in the children who died (23.5 and 62.5 days) as compared to the survivors (10.75 and 34 days) although not statistically significantly different [p=0.19 (los_icu), p=0.37 (los_hosp)]Median percentage of time pulse saturations (SpO2) remained < 75% was 22.4 + 12.3; >85% was 11.7 + 8.8 and within targeted range of 75%-85% was 62.8+ 9.4.No statistically significant correlation was found between the percentage of time saturations were l<75% or >85% or daily fluid balance with any of the studied outcomes. They were also not able to significantly predict any of the listed outcomes. However, lactate at 42 hr and beyond demonstrated moderate to strong association with los_icu (r=.55,p=.01). Lactate at 42 hr was also able to significantly predicted los_icu, F(1, 19) = 8.1, p =.01 accounting for 29.9% (R2) of the variation in los_icu (adjusted R2 = 26.3%) (figure 1). Multiple regression model(s) including lactate , fluid balance, cardiopulmonary bypass times and pulse oximetry times were not good.ConclusionOnly persistent hyperlactatemia at 42 hours showed an association and predicted increased length of ICU stay. Limitations of a single centre, retrospective nature and small sample size prevent generalization of these results. A larger prospective study alongside analysis of data from a larger single ventricular registry could provide more information about the utility of bedside etiometry data in studying patient journey and outcomes.Abstract 7970 Figure 1Linear regression model for lactate at 42 hours post operatively and ICU length of stay[Image Omitted. See PDF.]Abstract 7970 Table 1Patient demography and surgical characteristics[Image Omitted. See PDF.]Abstract 7970 Table 2Outcome parameters[Image Omitted. See PDF.]ReferencesPrimeaux J, Salavitabar A, Lu JC, Grifka RG, Figueroa CA. Characterization of post-operative hemodynamics following the norwood procedure using population data and multi-scale modeling. Front Physiol. 2021;12:603040. Published 2021 May 13. doi:10.3389/fphys.2021.603040Wasaki T, Takeuchi M, Taga N, Oe K, Shimizu K, Morita K. Masui. 2004;53(9):1008–1013.

• Publisher: BMJ Publishing Group LTD
• Subject: Blood pressure / Case Records / Clinical practice guidelines / Guidelines / Intensive care / Nursing / Patients / Pediatrics / Pharmacovigilance / Propofol / Side effects / Surveys / Training / Triglycerides