Comparison of pH-stat versus Alpha-stat during hypothermic cardiopulmonary bypass in the prevention and control of acidosis in cardiac surgery.
OBJECTIVE
To compare the effects of blood-gas management using either alpha-stat (temperature-uncorrected blood-gas management) or pH-stat (temperature-corrected blood-gas management) strategies, 30 patients undergoing coronary artery bypass surgery allocated randomly to either one of the approaches were studied. Acid-base balance, tissue oxygenation, and biochemical parameters were measured at distinct times: before bypass, after 15 min of hypothermia at 32 degrees C, after 45 min of hypothermia at 32 degrees C, after 15 min of rewarming at 37 degrees C, and 45 min after the end of bypass in normothermic conditions.


RESULTS
The groups were similar with regard to physical characteristics, physiological parameters, and bypass time. In the pH-stat group, CO2 administered with the aim of correcting pH for the patients hypothermic temperature caused a significant increase in temperature-uncorrected PaCO2 and a decrease in arterial temperature-uncorrected pH at 45 min. During the rewarming period and following bypass, the pH was lower and PaCO2 higher in the pH-stat group (P < 0.001).


CONCLUSIONS
It was found that during the rewarming period and following bypass, the resulting acidosis caused by the procedure was less in the alpha-stat group. It was found that there were no difference between the two groups, with regard to tissue perfusion, as is seen by the tissue oxygenation parameters and lactic acid concentration.
Piccioni
Marilde A
MA
Department of Anesthesiology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
Leirner
Adolfo A
AA
Auler
José O
JO
D000136:Acid-Base Equilibrium / Q000502:physiology*; D000142:Acidosis, Respiratory / Q000517:prevention & control*; D000368:Aged; D001831:Body Temperature / Q000502:physiology; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000097:blood; D001026:Coronary Artery Bypass; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007036:Hypothermia, Induced; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D017694:Rewarming
D002245:Carbon Dioxide; D019344:Lactic Acid