PERIOPERATIVE INTRAVENOUS SODIUM BICARBONATE TO PREVENT RENAL DYSFUNCTION AFTER OPEN HEART SURGERY
Abstract
Background: Renal dysfunction is acommon complication of cardiac surgery after cardiopulmonary bypass. Many interventions try to solve this problem.
Objective: to determine whether perioperative intravenous sodium bicarbonate can preserve renal function or not after cardiopulmonary bypass in cardiac surgery.
Patients and methods: Double blind controlled study was done in the period from March to September 2011 in cardiothoracic operating rooms then completed in surgical intensive care unit. Fifty patients were scheduled for elective valvular heart surgery and randomized into two groups, group A (25 patients) received IV sodium bicarbonate and group B (25 patients) received sodium chloride as control group.
Intervention:The patientsreceived IV sodium bicarbonate or sodium chloride after induction of anaesthesia.Sodium bicarbonate bolus dose 0.5 mmoL/kg diluted in 250 ml glucose 5% was given followed by 0.1 mmol/kg/h diluted in 1000 ml glucose postoperative in the first 24 hour maintenance infusion dose. Similar volumes of sodium chloride were given.
Results: There was no significant difference between two groups as regard personal data, type of valve surgery, cardio pulmonary bypass time,and aortic cross clamp time. There was significant decrease (P < 0.05)in total number of cases in which serum creatinine increased and acute kidney injury occured(in group A 14/25 and in group B 24/25). There was a significant difference between both groups regardingserumcreatinine and urinaryneutrophil gelatinase-associated lipocalin(NGAL)(P < 0.001). There was significant increase in acid base parameters (plasma PH, plasma bicarbonate, urinary PH) in group Acompared to group B.there was significant increase in serum sodium mean values in group A in comparison to group B at 6, 24, 48 and 72 h . Conclusion: Intravenous sodium bicarbonate can be used to attenuate serumcreatinineelevation andoccurrence of AKI after cardiopulmonary bypass in cardiac surgery without potential hazard on the patients
Key Words: Sodium bicarbonate, acute kidney injury,cardiopulmonary bypass.
Objective: to determine whether perioperative intravenous sodium bicarbonate can preserve renal function or not after cardiopulmonary bypass in cardiac surgery.
Patients and methods: Double blind controlled study was done in the period from March to September 2011 in cardiothoracic operating rooms then completed in surgical intensive care unit. Fifty patients were scheduled for elective valvular heart surgery and randomized into two groups, group A (25 patients) received IV sodium bicarbonate and group B (25 patients) received sodium chloride as control group.
Intervention:The patientsreceived IV sodium bicarbonate or sodium chloride after induction of anaesthesia.Sodium bicarbonate bolus dose 0.5 mmoL/kg diluted in 250 ml glucose 5% was given followed by 0.1 mmol/kg/h diluted in 1000 ml glucose postoperative in the first 24 hour maintenance infusion dose. Similar volumes of sodium chloride were given.
Results: There was no significant difference between two groups as regard personal data, type of valve surgery, cardio pulmonary bypass time,and aortic cross clamp time. There was significant decrease (P < 0.05)in total number of cases in which serum creatinine increased and acute kidney injury occured(in group A 14/25 and in group B 24/25). There was a significant difference between both groups regardingserumcreatinine and urinaryneutrophil gelatinase-associated lipocalin(NGAL)(P < 0.001). There was significant increase in acid base parameters (plasma PH, plasma bicarbonate, urinary PH) in group Acompared to group B.there was significant increase in serum sodium mean values in group A in comparison to group B at 6, 24, 48 and 72 h . Conclusion: Intravenous sodium bicarbonate can be used to attenuate serumcreatinineelevation andoccurrence of AKI after cardiopulmonary bypass in cardiac surgery without potential hazard on the patients
Key Words: Sodium bicarbonate, acute kidney injury,cardiopulmonary bypass.
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