Pro: Metabolic Acidosis Should be Corrected With Sodium Bicarbonate in Cardiac Surgical Patients

Abstract

METABOLIC ACIDOSIS, a commonly encountered acute management challenge during cardiac surgery, is typically a symptom of tissue hypoperfusion. It has many etiologies, though up to 30% of total cardiac cases have been associated with hyperlactatemia. 1 Mak NT Iqbal S de Varennes B et al. Outcomes of post-cardiac surgery patients with persistent hyperlactatemia in the intensive care unit: A matched cohort study. J Cardiothorac Surg. 2016; 11: 33 Crossref PubMed Scopus (19) Google Scholar Hypothermia, rewarming, anemia, hypoxia, shock, hypovolemia, ischemia-reperfusion injury, and gut-derived endotoxemia are all potential contributors to tissue hypoperfusion during cardiac surgery. Additionally, vasoconstrictors used commonly during cardiac surgery also may contribute to tissue hypoperfusion. Metabolic acidosis has been associated with increased morbidity and mortality, and an increased need for intraaortic balloon counterpulsation, blood product transfusion, and prolonged intubation and intensive care unit length of stay. 1 Mak NT Iqbal S de Varennes B et al. Outcomes of post-cardiac surgery patients with persistent hyperlactatemia in the intensive care unit: A matched cohort study. J Cardiothorac Surg. 2016; 11: 33 Crossref PubMed Scopus (19) Google Scholar , 2 Toraman F Evrenkaya S Yuce M et al. Lactic acidosis after cardiac surgery is associated with adverse outcome. Heart Surg Forum. 2004; 7: E155-E159 Crossref PubMed Google Scholar , 3 Basaran M Sever K Kafali E et al. Serum lactate level has prognostic significance after pediatric cardiac surgery. J Cardiothorac Vasc Anesth. 2006; 20: 43-47 Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar Although exogenous sodium bicarbonate (SB) administration is a common practice for acidosis correction in cardiac surgical patients, its use is highly controversial. In this manuscript, the authors outline the rationale and merits of using SB for the treatment of metabolic acidosis after cardiac surgery.