title: Sodium bicarbonate use and the risk of hypernatremia in thoracic aortic surgical patients with metabolic acidosis following deep hypothermic circulatory arrest.
abstract: OBJECTIVE
  Metabolic acidosis after deep hypothermic circulatory arrest (DHCA) for thoracic aortic operations is commonly managed with sodium bicarbonate (NaHCO 3 ). The purpose of this study was to determine the relationships between total NaHCO 3 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 NaHCO 3 dose administered through postoperative day 2, clinical variables, arterial blood gas values, and short-term clinical outcomes.
  
  
  RESULTS
  Seventy-five patients (86%) received NaHCO 3 . Total NaHCO 3 dose averaged 136 ± 112 mEq (range: 0.0-535 mEq) per patient. Total NaHCO 3 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 NaHCO 3 dose did not correlate with anion gap, serum chloride, not the duration of mechanical ventilator support, vasoactive infusions, ICU or hospital LOS.
  
  
  CONCLUSIONS
  Routine administration of NaHCO 3 was common for the management of metabolic acidosis after DHCA. Total dose of NaHCO 3 was a function of the severity and duration of metabolic acidosis. NaHCO 3 administration contributed to postoperative hypernatremia that was often severe. The total NaHCO 3 dose administered was unrelated to short-term clinical outcomes.
authors.affiliation: Department of Anesthesiology, Duke University, Durham, NC, USA.
authors.forename: Kamrouz
authors.initials: K
authors.lastname: Ghadimi
authors.affiliation: Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jacob T
authors.initials: JT
authors.lastname: Gutsche
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Phoenix, AZ, USA.
authors.forename: Harish
authors.initials: H
authors.lastname: Ramakrishna
authors.affiliation: Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Setegne
authors.affiliation: Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Jackson
authors.affiliation: Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: John G
authors.initials: JG
authors.lastname: Augoustides
authors.affiliation: Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: E Andrew
authors.initials: EA
authors.lastname: Ochroch
authors.affiliation: Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Weiss
authors.affiliation: Department of Surgery, Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.affiliation: Department of Anesthesiology, Stanford University, Stanford, CA, USA.
authors.forename: Albert T
authors.initials: AT
authors.lastname: Cheung
mesh_terms: D000138:Acidosis / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000139:chemically induced*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced*; D012189:Retrospective Studies; D012306:Risk; D017693:Sodium Bicarbonate / Q000009:adverse effects* / Q000627:therapeutic use; D019616:Thoracic Surgical Procedures; D055815:Young Adult
chemical_list: D017693:Sodium Bicarbonate