{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:12:09Z","timestamp":1753891929126,"version":"3.41.2"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T00:00:00Z","timestamp":1649289600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"Background<\/jats:title>Hyperlactemia after cardiopulmonary bypass is associated with adverse events during the early postoperative period in children. Serum lactate levels, a standard marker of anaerobic metabolism, are determined by the production, conversion and clearance of lactate, and may lag behind the anaerobic response. Here, we report a neonatal case under anaerobic conditions after cardiac surgery, whose expired gas parameters dramatically changed before a rise in blood lactate.<\/jats:p><\/jats:sec>Case Presentation<\/jats:title>A 23-day-old girl with tetralogy of Fallot was admitted to the pediatric intensive care unit after modified Blalock-Taussig shunt operation. As hemoconcentration increased and pleural fluid and ascites accumulated, we performed partial exchange transfusion to prevent shunt occlusion. Ten minutes after partial exchange transfusion, oxygen uptake and carbon dioxide production measured by indirect calorimetry suddenly dropped, while the respiratory quotient began to rise steeply before hyperlactatemia developed a few hours later.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Analysis of expired gas in critically ill children can detect the transition from aerobic to anaerobic conditions before hyperlactatemia.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2022.874969","type":"journal-article","created":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T06:03:40Z","timestamp":1649311420000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Novel Monitoring for Anaerobic Conditions Detected by Respiratory Quotient in a Critically Ill Pediatric Patient"],"prefix":"10.3389","volume":"10","author":[{"given":"Kenichiro","family":"Hayashi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hikoro","family":"Matsui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,4,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1016\/s0003-4975(97)00527-4","article-title":"Serum lactates correlate with mortality after operations for complex congenital heart disease.","volume":"64","author":"Cheifetz","year":"1997","journal-title":"Ann Thorac Surg."},{"key":"B2","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1067\/mtc.2000.106838","article-title":"Serial blood lactate measurements predict early outcome after neonatal repair or palliation for complex congenital heart disease.","volume":"120","author":"Charpie","year":"2000","journal-title":"J Thorac Cardiovasc Surg."},{"key":"B3","doi-asserted-by":"publisher","first-page":"217","DOI":"10.4103\/0971-9784.179589","article-title":"The role of blood lactate clearance as a predictor of mortality in children undergoing surgery for tetralogy of fallot.","volume":"19","author":"Ladha","year":"2016","journal-title":"Ann Card Anaesth."},{"key":"B4","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1177\/2150135120903977","article-title":"Hyperlactatemia: an update on postoperative lactate.","volume":"11","author":"Stephens","year":"2020","journal-title":"World J Pediatr Congenit Heart Surg."},{"key":"B5","first-page":"Ii14","article-title":"Gas exchange theory and the lactic acidosis (anaerobic) threshold.","volume":"81","author":"Wasserman","year":"1990","journal-title":"Circulation."},{"key":"B6","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1097\/00003246-199503000-00021","article-title":"Effect of hemorrhagic shock and reperfusion on the respiratory quotient in swine.","volume":"23","author":"Cohen","year":"1995","journal-title":"Crit Care Med."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-017-0288-z","article-title":"Venoarterial PCO2-to-arteriovenous oxygen content difference ratio is a poor surrogate for anaerobic metabolism in hemodilution: an experimental study.","volume":"7","author":"Dubin","year":"2017","journal-title":"Ann Intensive Care."},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1186\/s40635-017-0136-3","article-title":"Systemic and microcirculatory effects of blood transfusion in experimental hemorrhagic shock.","volume":"5","author":"Ferrara","year":"2017","journal-title":"Intensive Care Med Exp."},{"key":"B9","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1007\/s10877-018-0137-0","article-title":"An elevated respiratory quotient predicts complications after cardiac surgery under extracorporeal circulation: an observational pilot study.","volume":"33","author":"Piot","year":"2019","journal-title":"J Clin Monit Comput."},{"key":"B10","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.clnesp.2016.06.003","article-title":"Do picu patients meet technical criteria for performing indirect calorimetry?","volume":"15","author":"Beggs","year":"2016","journal-title":"Clin Nutr ESPEN."},{"key":"B11","doi-asserted-by":"publisher","first-page":"S1544","DOI":"10.21037\/jtd.2019.03.52","article-title":"Combination of O2 and CO2-derived variables to detect tissue hypoxia in the critically ill patient.","volume":"11","author":"Ospina-Tasc\u00f3n","year":"2019","journal-title":"J Thorac Dis."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1990","DOI":"10.1007\/s00134-004-2384-4","article-title":"Oxygen transport-the oxygen delivery controversy.","volume":"30","author":"Vincent","year":"2004","journal-title":"Intensive Care Med."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2020.00332","article-title":"Association between lactates, blood glucose, and systemic oxygen delivery in children after cardiopulmonary bypass.","volume":"8","author":"Klee","year":"2020","journal-title":"Front Pediatr."},{"key":"B14","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1007\/s00134-018-5213-x","article-title":"The ten pitfalls of lactate clearance in sepsis.","volume":"45","author":"Hernandez","year":"2019","journal-title":"Intensive Care Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1113\/expphysiol.2006.034363","article-title":"Physiological mechanisms dissociating pulmonary CO2 and O2 exchange dynamics during exercise in humans.","volume":"92","author":"Whipp","year":"2007","journal-title":"Exp Physiol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1177\/0267659116659919","article-title":"Carbon dioxide production during cardiopulmonary bypass: pathophysiology, measure and clinical relevance.","volume":"32","author":"Ranucci","year":"2017","journal-title":"Perfusion."}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.874969\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,7]],"date-time":"2022-04-07T06:03:45Z","timestamp":1649311425000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2022.874969\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,7]]},"references-count":16,"alternative-id":["10.3389\/fped.2022.874969"],"URL":"https:\/\/doi.org\/10.3389\/fped.2022.874969","relation":{},"ISSN":["2296-2360"],"issn-type":[{"type":"electronic","value":"2296-2360"}],"subject":[],"published":{"date-parts":[[2022,4,7]]},"article-number":"874969"}}