Sodium bicarbonate use and the risk of hypernatremia in thoracic aortic surgical patients with metabolic acidosis following deep hypothermic circulatory arrest.

Objective: Metabolic acidosis after deep hypothermic circulatory arrest (DHCA) for thoracic aortic operations is commonly managed with sodium bicarbonate (NaHCO3). The purpose of this study was to determine the relationships between total NaHCO3 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 NaHCO3 dose administered through postoperative day 2, clinical variables, arterial blood gas values, and short‑term clinical outcomes. Results: Seventy‑five patients (86%) received NaHCO3. Total NaHCO3 dose averaged 136 ± 112 mEq (range: 0.0–535 mEq) per patient. Total NaHCO3 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 NaHCO3 dose did not correlate with anion gap, serum chloride, not the duration of mechanical ventilator support, vasoactive infusions, ICU or hospital LOS. Conclusion: Routine administration of NaHCO3 was common for the management of metabolic acidosis after DHCA. Total dose of NaHCO3 was a function of the severity and duration of metabolic acidosis. NaHCO3 administration contributed to postoperative hypernatremia that was often severe. The total NaHCO3 dose administered was unrelated to short‑term clinical outcomes.

Aplicación clínica de la Ecocardiografía Transesofágica Intraoperatoria (ETE) para la evaluación intraoperatoria de la función valvular cardíaca

Una de las principales indicaciones para realizar la ecocardiografía transesofágica intraoperatoria (ETE) es la evaluación de la función valvular cardíaca. La ETE, es un instrumento poderoso para proveer información anatómica detallada y descripción funcional de las disfunciones valvulares. Se utiliza para determinar: el tipo de cirugía que puede ser realizada, la posibilidad del reparo valvular y la evaluación del éxito de las valvuloplastias o los reemplazos valvulares. Las técnicas ecocardiográficas para evaluar la anatomía y la función de las lesiones valvulares estenóticas y regurgitantes, emplean el uso del ultrasonido bidimensional, doppler de pulso, doppler de onda continua y estudios imageneológicos utilizando doppler a color