Hemodynamic effects of sodium bicarbonate in critically ill neonates.

Détails

ID Serval
serval:BIB_BFAF1EF7FE4B
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Hemodynamic effects of sodium bicarbonate in critically ill neonates.
Périodique
Intensive care medicine
Auteur(s)
Fanconi S., Burger R., Ghelfi D., Uehlinger J., Arbenz U.
ISSN
0342-4642
Statut éditorial
Publié
Date de publication
1993
Peer-reviewed
Oui
Volume
19
Numéro
2
Pages
65-9
Langue
anglais
Notes
Publication types: Clinical Trial ; Journal Article - Publication Status: ppublish
Résumé
OBJECTIVE: To analyze the cardiovascular effects of sodium bicarbonate in neonates with metabolic acidosis. DESIGN: Prospective, open, non-randomized, before-after intervention study with hemodynamic measurements performed before and 1, 5, 10, 20, and 30 min after bicarbonate administration. SETTING: Neonatal intensive care unit, tertiary care center. PATIENTS: Sequential sample of 16 paralysed and mechanically ventilated newborn infants with a metabolic acidosis (pH < 7.25 in premature and < 7.30 in term infants, base deficit > -8). INTERVENTION: An 8.4% sodium bicarbonate solution diluted 1:1 with water (final osmolality of 1000 mOsm/l) was administered in two equal portions at a rate of 0.5 mmol/min. The dose in mmol was calculated using the formula "base deficit x body weight (kg) x 1/3 x 1/2". MEASUREMENTS AND RESULTS: Sodium bicarbonate induced a significant but transient rise in pulsed Doppler cardiac output (CO) (+27.7%), aortic blood flow velocity (+15.3%), systolic blood pressure (BP) (+9.3%), (+14.6%), transcutaneous carbon dioxide pressure (PtcCO2) (+11.8%), and transcutaneous oxygen pressure (PtcO2) (+8%). In spite of the PaCO2 elevation, pH significantly improved (from a mean of 7.24 to 7.30), and the base deficit decreased (-39.3%). Calculated systemic vascular resistance (SVR) (-10.7%) and diastolic BP (-11.7%) decreased significantly, while PaO2 and heart rate (HR) did not change. Central venous pressure (CVP) (+6.5%) increased only slightly. By 30 min after bicarbonate administration all hemodynamic parameters, with the exception of the diastolic BP, had returned to baseline. CONCLUSION: Sodium bicarbonate in neonates with metabolic acidosis induces an increase in contractility and a reduction in afterload.
Mots-clé
Acidosis, Lactic, Bicarbonates, Birth Weight, Blood Gas Analysis, Blood Gas Monitoring, Transcutaneous, Critical Illness, Echocardiography, Doppler, Gestational Age, Hemodynamics, Humans, Infant, Newborn, Infant, Premature, Infusions, Intravenous, Intensive Care Units, Neonatal, Intervention Studies, Myocardial Contraction, Prospective Studies, Respiration, Artificial, Sodium, Sodium Bicarbonate
Pubmed
Web of science
Création de la notice
25/01/2008 11:06
Dernière modification de la notice
20/08/2019 16:34
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