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Acute normovolaemic haemodilution does not aggravate gastric mucosal acidosis during cardiac surgery

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Abstract

Objective Acute normovolaemic haemodilution with subsequent autologous blood transfusion after surgery is widely used to reduce homologous blood requirements during cardiac surgery. The hypothesis tested was whether a low intraoperative haematocrit (Hct) resulting from haemodilution decreases gastric mucosal pH (pHi).

Design Prospective clinical investigation.

Setting University Hospital of Vienna, Austria.

Patients 16 consecutive patients scheduled for elective cardiac surgery.

Interventions The patients were randomly assigned to one of two groups: In 10 patients (group 1), 500 ml of blood was withdrawn and stored after anaesthesia induction. An equal amount of 6 % hydroxyethyl starch was simultaneously infused. After discontinuation of cardiopulmonary bypass (CPB), the autologous blood unit was transfused. Six patients (group 2), who were not subjected to haemodilution and autologous blood transfusion served as controls. In all patients, a gastric tonometry probe was inserted.

Measurements and results Measurements of pHi and Hct were performed before and after acute normovolaemic haemodilution, during pulsatile hypothermic (30–32 °C) CPB, after rewarming, and 30 min after autologous blood transfusion in group 1, and at corresponding time intervals in group 2. Repeated measures analysis of variance and the Mann-Whitney U test were used for statistical analysis. Data are presented as means ± standard error of the mean. Haemodilution in group 1 caused a significant and persistent decrease in Hct (after haemodilution in group 1 34 ± 1 vs 40 ± 1 % in group 2). In both groups, pHi decreased during rewarming and after termination of CPB. However, in group 1, pHi was better preserved than in group 2 (rewarming: 7.44 ± 0.02 vs 7.34 ± 0.04; after CPB: 7.38 ± 0.03 vs 7.28 ± 0.02; p < 0.05).

Conclusions Acute normovolaemic haemodilution does not aggravate gastric mucosal acidosis during cardiac surgery.

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Authors and Affiliations

  1. Department of Anesthesiology and General Intensive Care, University of Vienna, AKH, Währinger Gürtel 18-20, A-1090, Vienna, Austria

    A. Bacher, N. Mayer, A. M. Rajek & W. Haider

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  1. A. Bacher
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  2. N. Mayer
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  3. A. M. Rajek
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  4. W. Haider
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Correspondence to A. Bacher.

Additional information

This study was performed at the Department of Anaesthesiology and General Intensive Care, University of Vienna, Austria. The study was financed with the department’s own financial resources. The study was presented in part at the 26th Educational & Scientific Symposium of the Society of Critical Care Medicine, 6–10 February 1997, San Diego, California, USA

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Bacher, A., Mayer, N., Rajek, A.M. et al. Acute normovolaemic haemodilution does not aggravate gastric mucosal acidosis during cardiac surgery. Intensive Care Med 24, 313–321 (1998). https://doi.org/10.1007/s001340050573

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