Metabolic Acidosis Assessment in High-Risk Surgeries: Prognostic Importance

Silva, João Manoel da; Oliveira, Amanda Maria Ribas Rosa de; Nogueira, Fernando Augusto Mendes; Vianna, Pedro Monferrari Monteiro; Amêndola, Cristina Prata; Carmona, Maria José Carvalho; Malbouisson, Luíz Marcelo Sá

doi:10.1213/ane.0000000000001575

Cited by 11 publications

(5 citation statements)

References 47 publications

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“…However, major surgery often causes postoperative metabolic acidosis [56]. Particularly after pulmonary resection, respiratory compensation decreases and leads to severe postoperative metabolic acidosis, which is associated with the worst postoperative outcomes [57]. Therefore, strict acid–base control is crucial in ESRD patients.…”

Section: Resultsmentioning

confidence: 99%

Recommendations for perioperative management of lung cancer patients with comorbidities

Tsubochi

Shibano

Endo

2017

Gen Thorac Cardiovasc Surg

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ObjectivesTo improve surgical outcomes, clinicians must provide optimal perioperative care for comorbidities identified as significant factors in risk models for patients undergoing lung cancer surgery.MethodsWe reviewed trends in perioperative care for idiopathic pulmonary fibrosis, cardiovascular diseases, and end-stage renal diseases in patients undergoing lung cancer surgery, as large clinical databases indicate that these comorbidities are significant risk factors for lung cancer surgery. Articles identified by keyword searches were included in the analysis.ResultsSignificant predictive factors for acute exacerbation of idiopathic pulmonary fibrosis were identified. However, no effective perioperative care was identified for prevention of acute exacerbation of interstitial pneumonia. The timing of coronary revascularization and antithrombotic management for cardiovascular diseases are subjects of ongoing research, and acid–base balance is essential in the management of hemodialysis patients with end-stage renal diseases.ConclusionsTo improve surgical outcomes for lung cancer patients, future studies should continue to study optimal perioperative management of comorbidities.

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Section: Resultsmentioning

confidence: 99%

Recommendations for perioperative management of lung cancer patients with comorbidities

Tsubochi

Shibano

Endo

2017

Gen Thorac Cardiovasc Surg

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“…Previous studies addressing postoperative acid-base balance and outcome have focused primarily on metabolic acidosis while defining this as a decrease in BE, with decreased BE due to hyperlactatemia associated with increased mortality (Silva Jr. et al 2016 ; Rutherford et al 1992 ). In our study, we used LOS as outcome measure as well as the occurrence of major morbid events (e.g., AKI, unplanned ICU admission, mortality).…”

Section: Discussionmentioning

confidence: 99%

The hidden secrets of a neutral pH—blood gas analysis of postoperative patients according to the Stewart approach

et al. 2021

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Background The superiority of either the traditional or Stewart based approach to acid-base balance has focused primarily on analyzing metabolic acidemia, with little attention given to patients with neutral pH. In this study, we evaluate metabolic disturbances in patients in the immediate postoperative period focusing on patients with neutral pH, while comparing the Stewart and traditional approach. Methods We conducted a single center retrospective observational cohort study. Over a 17-month period, data on arterial blood gas analysis, electrolytes, and albumin on the morning after surgery were retrieved from patients admitted to the postsurgical high dependency unit (HDU). Albumin-corrected anion gap (AG), apparent (SIDa) and effective strong ion difference (SIDe), and strong ion gap (SIG) were calculated. Results Out of 1207 HDU admissions, 400 cases had a complete set of laboratory-data including albumin of which 281 presented with neutral pH (7.35 ≤ pH ≤ 7.45), 64 with acidemia (pH < 7.35) and 55 with alkalemia (pH > 7.45). In pH neutral patients, the following acidifying disturbances were found: SIDa was lowered in 101 (36%), and SIG was raised in 60 (21%). Base excess (BE) was decreased in 16 (6%) and corrected AG raised in 107 (38%). The alkalizing effect of hypoalbuminemia was present in 137 (49%). Out of 134 cases with normal BE and corrected AG, SIDa was lowered in 58 (43%). Out of 136 cases with normal SIDa and SIG, none had lowered BE and 28 increased AG (21%). Length of stay was significantly longer in patients with hypoalbuminemia, lowered SIDa, and increased corrected AG, but not decreased BE (hypoalbuminemia: 16 days vs. 10 days, P < 0.001; low SIDa: 15 days vs. 12 days, P = 0.015; increased AG: 16 days vs. 11 days, P < 0.001; low BE: 14 days vs. 13 days, P = 0.736). Conclusions Metabolic disturbances, characterized mainly by the presence of lowered SIDa, increased AG, and hypoalbuminemia, are frequent in our population with apparent neutral acid-base balance based on pH and base excess. These changes on the morning after surgery are associated with increased length of stay.

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“…Elevated serum lactate has been shown to be a marker for increased mortality in patients undergoing both cardiac and non-cardiac surgery 20,21 and normalization of lactate has been associated with improved mortality in sepsis. 22 A multicenter, randomized controlled trial (RCT) comparing lactate-guided resuscitation to standard of care in septic shock showed a significantly lower mortality in the lactate-guided group, although there were no significant differences in lactate levels between groups.…”

Section: Assessment Of Subcellular Energetic Statementioning

confidence: 99%

Subcellular Energetics and Metabolism: Potential Therapeutic Applications

Thiele

2017

Anesthesia &Amp; Analgesia

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Part I of this review discussed the similarities between embryogenesis, mammalian adaptions to hypoxia (primarily driven by Hypoxia Inducible Factor-1 [HIF-1]), ischemia-reperfusion injury (and its relationship with reactive oxygen species), hibernation, diving animals, cancer, and sepsis, and focused on the common characteristics that allow cells and organisms to survive in these states. Part II of this review describes techniques by which researchers gain insight into subcellular energetics and identify potential future tools for clinicians. In particular, P31 nuclear magnetic resonance to measure high energy phosphates, serum lactate measurements, the use of near infrared spectroscopy to measure the oxidation state of cytochrome aa3, and the ability of the protoporphyrin IX-triplet state lifetime technique to measure mitochondrial oxygen tension are discussed. Additionally, this review will discuss novel treatment strategies such as hyperbaric oxygen, preconditioning, exercise training, therapeutic gases, as well as inhibitors of HIF-1, HIF prolyl hydroxylase (PHD), and Peroxisome proliferator-activated receptors (PPARs).

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Metabolic Acidosis Assessment in High-Risk Surgeries: Prognostic Importance

Cited by 11 publications

References 47 publications

Recommendations for perioperative management of lung cancer patients with comorbidities

Recommendations for perioperative management of lung cancer patients with comorbidities

The hidden secrets of a neutral pH—blood gas analysis of postoperative patients according to the Stewart approach

Subcellular Energetics and Metabolism: Potential Therapeutic Applications

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