ISSN:
1432-1238
Keywords:
Sodium bicarbonate
;
Neonates
;
Metabolic acidosis
;
Hemodynamics
;
Pulsed Doppler
;
Cardiac output
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract Objective To analyze the cardiovascular effects of sodium bicarbonate in neonates with metabolic acidosis. Design Prospective, open, non-randomized, before-after intervention study with hemodynamic measurements performed before and 1, 5, 10, 20, and 30 min after bicarbonate administration. Setting Neonatal intensive care unit, tertiary care center. Patients Sequential sample of 16 paralysed and mechanically ventilated newborn infants with a metabolic acidosis (pH〈7.25 in premature and 〈7.30 in term infants, base deficit〉−8). Intervention An 8.4% sodium bicarbonate solution diluted 1∶1 with water (final osmolality of 1000 mOsm/l) was administered in two equal portions at a rate of 0.5 mmol/min. The dose in mmol was calculated using the formula “base deficit x body weight (kg)×1/3×1/2”. Measurements and results Sodium bicarbonate induced a significant but transient rise in pulsed Doppler cardiac output (CO) (+27.7%), aortic blood flow velocity (+15.3%), systolic blood pressure (BP) (+9.3%), (+14.6%), transcutaneous carbon dioxide pressure (PtcCO2) (+11.8%), and transcutaneous oxygen pressure (PtcO2) (+8%). In spite of the PaCO2 elevation, pH significantly improved (from a mean of 7.24 to 7.30), and the base deficit decreased (−39.3%). Calculated systemic vascular resistance (SVR) (−10.7%) and diastolic BP (−11.7%) decreased significantly, while PaO2 and heart rate (HR) did not change. Central venous pressure (CVP) (+6.5%) increased only slightly. By 30 min after bicarbonate administration all hemodynamic parameters, with the exception of the diastolic BP, had returned to baseline. Conclusion Sodium bicarbonate in neonates with metabolic acidosis induces an increase in contractility and a reduction in afterload.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF01708362
