Metabolic Alkalosis in the Pediatric Cardiac Intensive Care Unit-A Prospective Observational Study.

IF 1.7 4区医学 Q2 ANESTHESIOLOGY

Pediatric Anesthesia Pub Date : 2025-09-01 Epub Date: 2025-04-02 DOI:10.1111/pan.15104

Diana Thomas, Suneel P Raman, Baiju S Dharan

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引用次数: 0

Abstract

Background: Metabolic alkalosis in pediatric patients following cardiac surgery warrants a comprehensive study. Newer methods of arterial blood gas (ABG) assessment can offer more insights into the mechanisms behind such derangement.

Objective(s): To study the incidence of metabolic alkalosis in postsurgical infants admitted to the pediatric cardiac intensive care unit and analyze factors associated with its development and its effect on prognosis.

Design: Prospective observational study.

Setting: Tertiary care teaching hospital in India during 2020-2021.

Patients: One hundred four infants < 1 year of age undergoing elective cardiac surgery and who required more than 6 h of postoperative mechanical ventilation were included. Infants on preoperative mechanical ventilation or with metabolic alkalosis were excluded.

Main outcome measures: Incidence of metabolic alkalosis and causative preoperative, intraoperative, and postoperative factors were studied along with their morbidity profile.

Results: Metabolic alkalosis was detected in 23 (22.1%) subjects. In group MA (who developed metabolic alkalosis), 73.9% of infants belonged to risk adjustment for congenital heart surgery-1 (RACHS-1) category 3 and above (p = 0.009). They also had longer cardiopulmonary bypass time (200.04 ± 83.35 min vs. 144.59 ± 64.77; 95% confidence interval of the difference in means [23, 87.9]), longer cross-clamp time (119.78 ± 63.12 min vs. 84.95 ± 48.8; 95% CI [10.4, 59.3]), greater application of modified ultrafiltration (MUF) (91.3% vs. 60.5%, p = 0.005), and larger volume of MUF removed (60 (44.4, 70) ml kg^-1 vs. 44.44 (32.9, 54.3), p = 0.003). Partitioning of base excess showed similar standard base excess due to free water (SBE_FW) (MA -0.18 ± 0.94 vs. No MA 0.25 ± 1.1; confidence interval of the difference in means [-0.95, 0.09]) and due to chloride (SBE_Cl) (MA -5.7 ± 4.8 vs. No MA -5.18 ± 5.05; 95% CI [-2.9, 1.8]) in both groups. A longer period of ventilation, intensive care unit stay, and hospital stay were found in group MA.

Conclusion: This prospective study on postcardiotomy infants revealed a much lower incidence of metabolic alkalosis than historical data. Physicochemical analysis of the blood samples for mechanisms underlying metabolic alkalosis found that its development is not entirely dependent on overt volume depletion or significant chloride loss. The administration of chloride-containing solutions appears to mitigate both the occurrence and severity of metabolic alkalosis.

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儿童心脏重症监护病房的代谢性碱中毒——一项前瞻性观察研究。

背景：儿童心脏手术后代谢性碱中毒值得全面研究。最新的动脉血气（ABG）评估方法可以为这种紊乱背后的机制提供更多的见解。目的：研究儿科心脏重症监护病房住院的术后婴儿代谢性碱中毒的发生率，分析其发生的相关因素及其对预后的影响。设计：前瞻性观察研究。环境：2020-2021年期间在印度的三级护理教学医院。主要结局指标：研究代谢性碱中毒的发生率及其术前、术中、术后的致病因素及其发病率。结果：代谢性碱中毒23例（22.1%）。MA组（发生代谢性碱中毒）73.9%的婴儿属于先天性心脏手术风险调整-1 (RACHS-1) 3类及以上（p = 0.009）。他们的体外循环时间也更长(200.04±83.35 min vs. 144.59±64.77 min；平均值差的95%可信区间[23,87.9])，较长的交叉夹钳时间(119.78±63.12 min vs. 84.95±48.8；95% CI[10.4, 59.3])，改良超滤（MUF）的应用范围更广（91.3%比60.5%,p = 0.005）， MUF去除量更大(60 （44.4,70)ml kg-1比44.44 (32.9,54.3),p = 0.003）。碱基过量的分配表现出与自由水（SBEFW）相似的标准碱基过量(MA -0.18±0.94 vs. No MA 0.25±1.1；平均值差的置信区间[-0.95,0.09])和由于氯化物（SBECl） (MA -5.7±4.8 vs. No MA -5.18±5.05；95% CI[-2.9, 1.8])。MA组患者通气时间、重症监护时间和住院时间均较长。结论：这项对心脏切开后婴儿的前瞻性研究显示代谢性碱中毒的发生率比历史数据低得多。对血液样本进行代谢性碱中毒机制的理化分析发现，其发展并不完全依赖于明显的体积消耗或显著的氯化物损失。施用含氯溶液似乎可以减轻代谢性碱中毒的发生和严重程度。

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来源期刊

Pediatric Anesthesia 医学-麻醉学

CiteScore

3.20

自引率

11.80%

发文量

222

审稿时长

3-8 weeks

期刊介绍： Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.