A physical chemical approach to the analysis of acid-base balance in the clinical setting

Gilfix, Brian M.; Bique, Mark; Magder, Sheldon

doi:10.1016/0883-9441(93)90001-2

Cited by 194 publications

(158 citation statements)

References 14 publications

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“…In addition, hyperlactatemia during cardiopulmonary bypass (CPB) is an early predictor of morbidity and mortality in pediatric patients (Munoz et al 2000, Ranucci et al 2006. However, some confounding factors, such as the inhibition of pyruvate dehydrogenase, enhanced glycolysis, and an exogenous lactate load from red blood cells, can decrease the predictive power of lactate levels (McAuliffe et al 1986, Gilfix et al 1993.…”

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confidence: 99%

Intraoperative Plasma Lactate as an Early Indicator of Major Postoperative Events in Pediatric Cardiac Patients

Park

Kim

Byon

et al. 2012

Tohoku J. Exp. Med.

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Hyperlactatemia and unmeasured anions (UMA) have been suggested to be useful predictors of outcomes after pediatric cardiac surgery in the ICU. However, if we detect high-risk patient in the operating room, we could practice early intervention to decrease mortality and morbidity. The purpose of this study was to determine whether the intraoperative lactate or UMA levels can predict adverse outcomes in pediatric cardiac patients with undergoing cardiopulmonary bypass (CPB). We studied 102 patients with congenital heart disease. Arterial blood samples were obtained after inducing anesthesia, 5 min after weaning from CPB and after chest closure. Major adverse events (MAEs) were defined as cardiac compression, re-sternotomy due to hemodynamic instability, extra-corporeal membrane oxygenator support, creatinine levels greater than 2 mg/dL, or death. Patients were divided into MAE group (8 patients, 7.8%) and non-MAE group. Six patients with MAEs died. Importantly, the lactate levels (mmol/L) at weaning from CPB (4.19 vs 2.1; MAE group vs non-MAE group), chest closure (5.76 vs 2.39; MAE group vs non-MAE group) and the intraoperative increases in lactate levels were significantly higher in the MAE group than in the non-MAE group. However, there was no significant difference in the UMA levels or their changes between the groups. The increase in the lactate level from CPB weaning to chest closure was the best predictor of MAEs (AUC: 0.810). In conclusion, the intraoperative plasma lactate levels were more closely associated with MAEs, and they are more useful for predicting the outcome of pediatric cardiac patients than the UMA levels.

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confidence: 99%

Intraoperative Plasma Lactate as an Early Indicator of Major Postoperative Events in Pediatric Cardiac Patients

Park

Kim

Byon

et al. 2012

Tohoku J. Exp. Med.

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“…They examined the use of three different measures in the assessment of unidenti®ed ions in these patients [28]. They looked at the SIG, the anion gap and also what they de®ne as a Ôbase excess gapÕ.…”

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confidence: 99%

Acid−base physiology: the ‘traditional’ and the ‘modern’ approaches

et al. 2002

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The interpretation and understanding of acid±base dysfunction has recently been revisited. The ÔtraditionalÕ approach developed from the pioneering work of Henderson and Hasselbalch and is still the most widely used in clinical practice. There are a number of problems identi®ed with this approach, however. The ÔmodernÕ approach derives from Stewart's work in physical chemistry. In this review we describe the origins of the traditional approach and discusses related concepts. We then describe Stewart's approach, including how it is derived and how it may be used to classify acid±base derangements. The applications of Stewart's approach to clinical scenarios in intensive care is then discussed brie¯y before we examine some published clinical studies based on his work.

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“…The nonketotic hyperosmolar state of diabetes has been associated with an increased AG that remains unexplained [34]. Unmeasured anions have been reported in the blood of patients with sepsis [35,36], patients with liver disease [37,38], and experimental animals that received endotoxin [39]. These anions may be the source of much of the unexplained acidosis seen in patients with critical illness [40].…”

Section: Clinical Utility Of Anion Gapmentioning

confidence: 95%