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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dc.contributor.authorGhadimi, Kamrouz
dc.contributor.authorGutsche, Jacob T
dc.contributor.authorRamakrishna, Harish
dc.contributor.authorSetegne, Samuel L
dc.contributor.authorJackson, Kirk R
dc.contributor.authorAugoustides, John G
dc.contributor.authorOchroch, E Andrew
dc.contributor.authorWeiss, Stuart J
dc.contributor.authorBavaria, Joseph E
dc.contributor.authorCheung, Albert T
dc.date.accessioned2016-09-23T04:23:30Z
dc.date.available2016-09-23T04:23:30Z
dc.date.issued2016-07
dc.description.abstractObjective: 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.en_US
dc.identifier.citationGhadimi 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.en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/177430
dc.language.isoenen_US
dc.source.urihttps://www.annals.in/article.asp?issn=0971-9784;year=2016;volume=19;issue=3;spage=454;epage=462;aulast=Ghadimien_US
dc.subjectDeep hypothermic circulatory arresten_US
dc.subjectHypernatremiaen_US
dc.subjectMetabolic acidosisen_US
dc.subjectSodium bicarbonateen_US
dc.titleSodium bicarbonate use and the risk of hypernatremia in thoracic aortic surgical patients with metabolic acidosis following deep hypothermic circulatory arrest.en_US
dc.typeArticleen_US
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