Systemic acidemia impairs cardiac function in critically Ill patients.

S Rodríguez-Villar,I Awad,C Harris,C Brathwaite-Shirley,J Arévalo-Serrano,V Recea,B Gurung,A Spataru,R Reece-Anthony,S Vanapalli,A Collins,Sg Sakka,L Thompson,M Toolan,Ja Kraut,P Eiben

doi:10.1016/j.eclinm.2021.100956

Abstract

BackgroundAcidemia, is associated with reduced cardiac function in animals, but no studies showing an effect of acidemia on cardiac function in humans are reported. In the present study, we examined the effect of acidemia on cardiac function assessed with transpulmonary thermodilution technique with integrated pulse contour analysis (Pulse Contour Cardiac Output, PiCCO™) in a large cohort of critically ill patients.MethodsThis was a prospective multicenter observational cross-sectional study of 297 patients from 6 intensive care units in London, England selected from all patients admitted consecutively between May 2018 and March 2019. Measurements of lowest plasma pH and concurrent assessment of cardiac function were obtained.FindingsThere was a significant difference between two pH categories (pH ≤ 7.28 vs. pH > 7.28) for the following variables of cardiac function: SVI (difference in means 32.7; 95% CI: 21 to 45 mL/m2; p < 0.001); GEF (18; 95% CI: 11 to 26%; p < 0.001), dPmax (-331; 95% CI: -510 to -153 mmHg/s; p = 0.001), CFI (0.7; 95% CI: 0.2 to 1.3 1/min; p = 0.01) and CPI (0.09; 95% CI: 0.03 to 0.15 W/m2; p < 0.001). However, there was no significant difference in CI (0.13; 95% CI: -0.20 to 0.47 L/min/m2; p = 0.12) between the pH categories. Also, a significant relationship was found between the quantitative pH and the following variables: SVI (132; 95% CI: 77 to 188 mL/m2; p < 0.001), GEF (74.7; 95% CI: 37.1 to 112.4%; p < 0.001), dPmax (-1587; 95% CI: -2361 to -815 mmHg/s; p < 0.001), CFI (3.5; 95% CI: 0.9 to 6.1 /min; p = 0.009), CPI (0.62; 95% CI: 0.36 to 0.88 W/m2; p < 0.001) and CI (regression coefficient 1.96; 95% CI:0.45 to 3.47 L/min/m2; p = 0.01).InterpretationAcidemia is associated with impaired cardiac function in seriously ill patients hospitalized in the intensive care unit supporting the potential value of early diagnosis and improvement of arterial pH in these patients.FundingThe study was partially supported by unrestricted funds from the UCLA School of Medicine.

Highlights

Lactic acidosis with acidemia is common in seriously ill patients hospitalized in the intensive care unit (ICU), those with underlying sepsis
We examined the relationship between systemic acidemia and several measures of cardiac function obtained using a sensitive and specific monitoring device, the transpulmonary thermodilution technique with integrated pulse contour analysis (PiCCOTM, Pulsion, Maquet Getinge Group) in 297 seriously ill patients admitted to six ICUs from hospitals in London, England
Previous studies in normal dogs showed that cardiac function was impaired when the systemic pH fell finding consistent with the hypothesis that the acidemia can contribute to abnormal cardiac function by measuring the left ventricular diastolic volume (LFDV) and left ventricular end-systolic pressurevolume relation (ESPVR) [4À5]

Summary

Introduction

Lactic acidosis with acidemia is common in seriously ill patients hospitalized in the intensive care unit (ICU), those with underlying sepsis. Findings: There was a significant difference between two pH categories (pH 7.28 vs pH > 7.28) for the following variables of cardiac function: SVI (difference in means 32.7; 95% CI: 21 to 45 mL/m2; p < 0.001); GEF (18; 95% CI: 11 to 26%; p < 0.001), dPmax (-331; 95% CI: -510 to -153 mmHg/s; p = 0.001), CFI (0.7; 95% CI: 0.2 to 1.3 1/min; p = 0.01) and CPI (0.09; 95% CI: 0.03 to 0.15 W/m2; p < 0.001). Interpretation: Acidemia is associated with impaired cardiac function in seriously ill patients hospitalized in the intensive care unit supporting the potential value of early diagnosis and improvement of arterial pH in these patients.

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