sodium-bicarbonate and Cardiac-Output--Low

Topics: Acidosis, Lactic; Adenosine Triphosphate; Brain; Cardiac Output, Low; Humans; Hydrogen-Ion Concentration; Sodium Bicarbonate

Topics: Acidosis, Lactic; Acute Disease; Animals; Bicarbonates; Carbon Dioxide; Cardiac Output, Low; Humans; Hypoxia; Resuscitation; Sodium; Sodium Bicarbonate

The aim of this study was to evaluate outcome measures between our standard multidose cardioplegia protocol and a del Nido cardioplegia protocol in congenital heart surgery patients.. Retrospective single-center study including 250 consecutive patients that received del Nido cardioplegia (DN group) with a mandatory reperfusion period of 30% of cross clamp time and 250 patients that received a modified St. Thomas' solution (ST group). Groups were matched by age, weight, gender, and Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores. Preoperative hematocrit and oxygen saturation were also recorded. Outcomes analyzed were the vasoactive inotropic score (VIS), lactate, ventilation time, ventricular dysfunction with low cardiac output syndrome (LCOS), intensive care unit (ICU) length of stay (LOS), hospital LOS, bypass and aortic cross-clamp times, and in-hospital mortality.. Both groups were comparable demographically. Statistically significant differences (p ⩽ 0.05) were noted for cardiac dysfunction with LCOS, hematocrit at end of surgery (p = 0.0038), VIS on ICU admission and at end of surgery (p = 0.0111), and ICU LOS (p = 0.00118) with patients in the DN group having more desirable values for those parameters. Other outcome measures did not reach statistical significance.. In our congenital cardiac surgery population, del Nido cardioplegia strategy was associated with less ventricular dysfunction with LCOS, a lower VIS and decreased ICU LOS compared with patients that received our standard myocardial protection using a modified St. Thomas' solution. Despite the limitation of this study, including its retrospective nature and cohort size, these data supported our transition to incorporate del Nido cardioplegia solution with a mandatory reperfusion period as the preferred myocardial protection method in our program.

Topics: Brazil; Cardiac Output, Low; Cardiac Surgical Procedures; Cardioplegic Solutions; Child; Electrolytes; Heart Arrest, Induced; Heart Defects, Congenital; Humans; Lactates; Lidocaine; Magnesium Sulfate; Mannitol; Potassium Chloride; Retrospective Studies; Sodium Bicarbonate; Solutions; Ventricular Dysfunction

The classic model for the effects of NaHCO3 on myocardial function predicts transient myocardial depression after an intravenous bolus of sodium bicarbonate in association with myocardial acidosis.. Five anesthetized, paralyzed, and ventilated dogs underwent midline sternotomy. Myocardial global function was assessed by cardiac output, left ventricular (LV) dp/dt, LV end-systolic, and LV end-diastolic pressures. Regional myocardial function assessed by measuring the LV regional end-systolic, LV end-diastolic lengths, and LAD coronary blood flow. Coronary sinus, intramyocardial and arterial pH were measured as was free serum Ca++. Animals were made acidemia by infusion of 0.3 N HCl and then given a bolus of sodium bicarbonate. This produced transient depression followed by recovery of myocardial function.. During the depression phase there was no significant decrease in interstitial pH or an increase in A-VCO2 difference as predicted by the current model. However, there was a significant decrease in the serum free Ca++ that coincided with myocardial depression.. We could not confirm the predictions of the classic model and hypothesize that myocardial depression may be caused by decreased availability of free Ca++ of decreased Ca++ flux rather than intracellular acidosis.

Topics: Acidosis; Animals; Calcium; Carbon Dioxide; Cardiac Output, Low; Depression, Chemical; Dogs; Heart Function Tests; Infusions, Intravenous; Injections, Intravenous; Myocardial Contraction; Partial Pressure; Sodium Bicarbonate

Topics: Bicarbonates; Cardiac Output, Low; Dialysis; Dialysis Solutions; Heart Rate; Humans; Hypotension; Sodium; Sodium Bicarbonate; Sympathetic Nervous System; Vascular Resistance