Sodium bicarbonate use and the risk of hypernatremia in thoracic aortic surgical patients with metabolic acidosis following deep hypothermic circulatory arrest.
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Date
2016-07
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Abstract
Objective: Metabolic acidosis after deep hypothermic circulatory arrest (DHCA) for thoracic aortic operations
is commonly managed with sodium bicarbonate (NaHCO3). The purpose of this study was to determine the
relationships between total NaHCO3 dose and the severity of metabolic acidosis, duration of mechanical
ventilation, duration of vasoactive infusions, and Intensive Care Unit (ICU) or hospital length of stay (LOS).
Methods: In a single center, retrospective study, 87 consecutive elective thoracic aortic operations utilizing
DHCA, were studied. Linear regression analysis was used to test for the relationships between the total
NaHCO3 dose administered through postoperative day 2, clinical variables, arterial blood gas values,
and short‑term clinical outcomes. Results: Seventy‑five patients (86%) received NaHCO3. Total NaHCO3
dose averaged 136 ± 112 mEq (range: 0.0–535 mEq) per patient. Total NaHCO3 dose correlated with
minimum pH (r = 0.41, P < 0.0001), minimum serum bicarbonate (r = −0.40, P < 0.001), maximum serum
lactate (r = 0.46, P = 0.007), duration of metabolic acidosis (r = 0.33, P = 0.002), and maximum serum
sodium concentrations (r = 0.29, P = 0.007). Postoperative hypernatremia was present in 67% of patients and
peaked at 12 h following DHCA. Eight percent of patients had a serum sodium ≥ 150 mEq/L. Total NaHCO3
dose did not correlate with anion gap, serum chloride, not the duration of mechanical ventilator support,
vasoactive infusions, ICU or hospital LOS. Conclusion: Routine administration of NaHCO3 was common
for the management of metabolic acidosis after DHCA. Total dose of NaHCO3 was a function of the severity
and duration of metabolic acidosis. NaHCO3 administration contributed to postoperative hypernatremia
that was often severe. The total NaHCO3 dose administered was unrelated to short‑term clinical outcomes.
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Keywords
Deep hypothermic circulatory arrest, Hypernatremia, Metabolic acidosis, Sodium bicarbonate
Citation
Ghadimi Kamrouz, Gutsche Jacob T, Ramakrishna Harish, Setegne Samuel L, Jackson Kirk R, Augoustides John G, Ochroch E Andrew, Weiss Stuart J, Bavaria Joseph E, Cheung Albert T. Sodium bicarbonate use and the risk of hypernatremia in thoracic aortic surgical patients with metabolic acidosis following deep hypothermic circulatory arrest. Annals of Cardiac Anaesthesia. 2016 July; 19(3): 454-462.