TY - JOUR
T1 - Intraoperative regional myocardial acidosis predicts the need for inotropic support in cardiac surgery
AU - Kumbhani, Dharam J.
AU - Healey, Nancy A.
AU - Birjiniuk, Vladimir
AU - Crittenden, Michael D.
AU - Treanor, Patrick R.
AU - Al-Tabbaa, Amer K.
AU - Khuri, Shukri F.
N1 - Funding Information:
Supported by the Richard Warren Surgical Research and Educational Fund, Westwood, MA.
PY - 2004/11
Y1 - 2004/11
N2 - To determine the impact of regional myocardial acidosis encountered during cardiac surgery on the need for inotropic and intra-aortic balloon (IAB) support. Intramyocardial tissue pH 37C was measured in 247 patients undergoing cardiopulmonary bypass (CPB). Inotropic support (INO) was defined as requiring one or more of norepinephrine/epinephrine/amrinone/dobutamine/>2.5 μg/kg/min dopamine, for at least 45 minutes intraoperatively, and intraoperative or postoperative IAB use. PH (corrected to 37°C, pH 37C) during surgery was compared in patients who needed INO versus those who did not. Multivariate logistic regression models identified the determinants of INO. Fifty patients (20.2%) required INO intraoperatively. pH 37C was significantly lower throughout reperfusion in patients needing INO. Preoperative ejection fraction and pH 37C during reperfusion were identified as independent predictors of INO. This is the first study to show that intraoperative regional myocardial acidosis, a preventable condition, independently determines the need for intraoperative INO. Increased INO is associated with greater postoperative mortality and morbidity.
AB - To determine the impact of regional myocardial acidosis encountered during cardiac surgery on the need for inotropic and intra-aortic balloon (IAB) support. Intramyocardial tissue pH 37C was measured in 247 patients undergoing cardiopulmonary bypass (CPB). Inotropic support (INO) was defined as requiring one or more of norepinephrine/epinephrine/amrinone/dobutamine/>2.5 μg/kg/min dopamine, for at least 45 minutes intraoperatively, and intraoperative or postoperative IAB use. PH (corrected to 37°C, pH 37C) during surgery was compared in patients who needed INO versus those who did not. Multivariate logistic regression models identified the determinants of INO. Fifty patients (20.2%) required INO intraoperatively. pH 37C was significantly lower throughout reperfusion in patients needing INO. Preoperative ejection fraction and pH 37C during reperfusion were identified as independent predictors of INO. This is the first study to show that intraoperative regional myocardial acidosis, a preventable condition, independently determines the need for intraoperative INO. Increased INO is associated with greater postoperative mortality and morbidity.
KW - Cardiovascular agents
KW - Cardiovascular surgery
KW - Intraoperative monitoring
KW - Ischemia
KW - Myocardial revascularization
KW - Reperfusion injury
UR - http://www.scopus.com/inward/record.url?scp=8544232749&partnerID=8YFLogxK
U2 - 10.1016/j.amjsurg.2004.07.015
DO - 10.1016/j.amjsurg.2004.07.015
M3 - Article
C2 - 15546553
AN - SCOPUS:8544232749
SN - 0002-9610
VL - 188
SP - 474
EP - 480
JO - American journal of surgery
JF - American journal of surgery
IS - 5
ER -