sodium-bicarbonate and Multiple-Organ-Failure

To explore the use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia due to septic shock.. In this prospective randomized, double-blind, controlled clinical trial, a total of 65 patients of hypoperfusion induced lactic acidemia due to septic shock admitted between April 2006 and April 2010 were assigned to two groups. Thirty-five patients of "stage" group sodium bicarbonate was used in two stages: in first stage sodium bicarbonate was given by venous drip until pH≥7.15, and in second stage sodium bicarbonate was given by intravenous drip till pH≥7.25 after 6 hours. Thirty patients in control group intravenous drip of sodium bicarbonate was used till pH≥7.15. Early goal-directed therapy(EGDT) was used in the first 6 hours of fluid resuscitation. The number of dysfunction organ, time of mechanical ventilation, maximum sequential organ failure assessment (SOFA) score, delta SOFA score, durations of stay in intensive care unit (ICU) and in hospital, and mortality were recorded in two groups. Blood gas analysis and index of hemodynamics were monitored at 0 hour and 8 hours in both groups.. Compared with control group, "stage" group was associated with a lower number of dysfunction organ, time of mechanical ventilation, maximum SOFA score, delta SOFA score, durations of stay in ICU and in hospital, and mortality (number of dysfunction organ: 2.68±0.79 vs. 3.28±0.80, time of mechanical ventilation: 10.32±2.26 days vs. 13.80±2.56 days, maximum SOFA score: 11.01±2.26 vs. 13.11±2.26, delta SOFA score: 1.71±1.25 vs. 3.43±1.27, duration of stay in ICU: 14.0±3.6 days vs. 20.0±3.7 days, duration of stay in hospital: 28.3±12.9 days vs. 41.9±13.2 days, mortality: 34.28% vs. 60.00%, P<0.05 or P<0.01). There were no significant differences in blood gas analysis and index of hemodynamics at 0 hour, and they were improved at 8 hours. Compared with control group, in "stage" group, lactic acid (Lac) was significantly lowered (1.50±1.08 mmol/L vs. 2.93±1.09 mmol/L), and pH, mixed venous oxygen saturation (SvO2), oxygen extraction ratio (O2ER), cardiac index (CI), oxygen delivery (DO2) were significantly increased (pH:7.29±0.05 vs. 7.20±0.05, SvO2: 0.75±0.18 vs. 0.66±0.17, O2ER: 0.32±0.06 vs. 0.25±0.06, CI: 113.36±13.34 ml×s(-1)×m(-2) vs. 83.35±13.34 ml×s(-1)×m(-2), DO2: 840±170 ml×min(-1)×m(-2) vs. 630±171 ml×min(-1)×m(-2), all P<0.01).. The use of sodium bicarbonate in stages in treating hypoperfusion induced lactic acidemia as a result of septic shock can lower the occurrence rate of multiple organ dysfunction syndrome, time of mechanical ventilation, durations of stay in ICU and in hospital, and mortality.

Topics: Acidosis, Lactic; Adult; Aged; Double-Blind Method; Female; Humans; Male; Middle Aged; Multiple Organ Failure; Prospective Studies; Shock, Septic; Sodium Bicarbonate

To compare the effects of sodium bicarbonate and lactate for continuous veno-venous hemodiafiltration (CVVHDF) in critically ill patients.. Prospective crossed-over controlled trial in the surgical and medical ICUs of a university hospital.. Eight patients with multiple organ dysfunction syndrome (MODS) requiring CVVHDF.. Each patient received the two buffers in a randomized sequence over two consecutive days.. The following variables were determined: acid-base parameters, lactate production and utilization ((13)C lactate infusion), glucose turnover (6,6(2)H(2)-glucose), gas exchange (indirect calorimetry). No side effect was observed during lactate administration. Baseline arterial acid-base variables were equal with the two buffers. Arterial lactate (2.9 versus 1.5 mmol/l), glycemia (+18%) and glucose turnover (+23%) were higher in the lactate period. Bicarbonate and glucose losses in CVVHDF were substantial, but not lactate elimination. Infusing (13)C lactate increased plasma lactate levels equally with the two buffers. Lactate clearance (7.8+/-0.8 vs 7.5+/-0.8 ml/kg per min in the bicarbonate and lactate periods) and endogenous production rates (14.0+/-2.6 vs 13.6+/-2.6 mmol/kg per min) were similar. (13)C lactate was used as a metabolic substrate, as shown by (13)CO(2) excretion. Glycemia and metabolic rate increased significantly and similarly during the two periods during lactate infusion.. Lactate was rapidly cleared from the blood of critically ill patients without acute liver failure requiring CVVHDF, being transformed into glucose or oxidized. Lactate did not exert undesirable effects, except moderate hyperglycemia, and achieved comparable effects on acid-base balance to bicarbonate.

Topics: Acid-Base Equilibrium; Aged; Analysis of Variance; Blood Glucose; Buffers; Cross-Over Studies; Female; Hemodiafiltration; Humans; Lactic Acid; Male; Metabolic Clearance Rate; Middle Aged; Multiple Organ Failure; Prospective Studies; Sodium Bicarbonate; Water-Electrolyte Balance

Topics: Acidosis, Lactic; Acute Kidney Injury; Anti-Bacterial Agents; Comorbidity; Female; Humans; Hypothermia; Infusions, Intravenous; Metformin; Middle Aged; Multiple Organ Failure; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Renal Replacement Therapy; Sodium Bicarbonate; Urinary Tract Infections; Vasoconstrictor Agents

Topics: Acinetobacter baumannii; Acinetobacter Infections; Blood Loss, Surgical; Fatal Outcome; Female; Humans; Hypernatremia; Intraoperative Complications; Liver Transplantation; Middle Aged; Multiple Organ Failure; Myelinolysis, Central Pontine; Postoperative Complications; Sepsis; Sodium Bicarbonate; Transfusion Reaction

We report two drowning victims with hypothermic circulatory arrest who were resuscitated with the use of extracorporeal circulation (ECC). The first patient developed severe post-bypass pulmonary oedema and inspired us to use a leucocyte-depletion filter in the second patient to attenuate leucocyte-mediated pulmonary reperfusion injury.. In the first patient, a standard extracorporeal circuit was used. In the second patient, systemic leucocyte depletion was applied using leucocyte-depletion filters (Pall RS 1, Pall, Portsmouth, UK), in the venous side of the extracorporeal circuit. Circulating leucocyte counts were measured and arterial blood gas analysis and chest X-rays were performed.. Both patients showed a decrease of the circulating leucocyte counts during rewarming and had nearly similar leucocyte counts on arrival at the intensive care unit (ICU). The first patient developed severe pulmonary oedema, with poor arterial blood gases, whereas the second patient, who had leucocyte-depletion by filtration, did not develop severe pulmonary oedema, and had good arterial blood gases.. Profound leucocyte-depletion by means of filtration may have contributed to limit leucocyte-mediated pulmonary reperfusion injury.

Topics: Accidents, Traffic; Acidosis; Adult; Cardiotonic Agents; Child, Preschool; Dopamine; Extracorporeal Circulation; Fatal Outcome; Heart Arrest; Humans; Hypothermia; Leukocyte Reduction Procedures; Male; Multiple Organ Failure; Near Drowning; Polymerase Chain Reaction; Pulmonary Edema; Reperfusion Injury; Rewarming; Sodium Bicarbonate

Langerhans cell histiocytosis (LCH) is an enigmatic disease usually occurring in children. Tumor lysis syndrome (TLS) is a clinical syndrome associated with severe metabolic derangement and oliguric acute renal failure. In this report, we present the clinical course of an infant with advanced LCH who had TLS develop after chemotherapy. Treatment with continuous arteriovenous hemofiltration resulted in effective control of serum uric acid, potassium, creatinine, phosphorus, and blood urea nitrogen levels in the blood.

Topics: Acute Kidney Injury; Allopurinol; Antineoplastic Combined Chemotherapy Protocols; Biomarkers; Blood Transfusion; Combined Modality Therapy; Disease Progression; Etoposide; Fatal Outcome; Female; Fluid Therapy; Hemofiltration; Histiocytosis, Langerhans-Cell; Humans; Infant; L-Lactate Dehydrogenase; Lymph Nodes; Mercaptopurine; Multiple Organ Failure; Neck; Orbital Diseases; Prednisolone; Sodium Bicarbonate; Temporal Bone; Tumor Lysis Syndrome; Uric Acid; Vinblastine; Vincristine