Introduction
Materials and methods
Anesthesiological and intensive care treatments
Surgical and cardiopulmonary bypass treatments
Clinical treatments and outcomes
Indication and performance of renal replacement therapy
Statistical analysis
Results
Comparability of the study cohorts
Total cohort | Control - no bicarbonate | Intervention - bicarbonate | Significance, P-value | |
---|---|---|---|---|
Number
| 584 | 304 (52.1%) | 280 (47.9%) | |
Demographics
| ||||
Age, years | 68.5 (67, 69) | 68.5 (67, 70) | 68.5 (67, 70) | 0.675 |
Male | 381 (65.2%) | 201 (66.1%) | 180 (64.3%) | 0.706 |
Female | 203 (34.8%) | 103 (33.9%) | 100 (35.7%) | |
Height, cm | 171 (170, 172) | 171 (170, 173) | 171 (170, 172) | 0.741 |
Weight, Kg | 81.3 (79.9, 82.6) | 82.3 (80.6, 84.1) | 80.1 (78.1, 82.1) | 0.103 |
BMI (Kg/m2) | 27.2 (26.8, 27.7) | 27.4 (26.8, 27.9) | 26.9 (26.5, 27.8) | 0.098 |
Cardiovascular risk factors
| ||||
Diabetes mellitus | 158 (27.1%) | 72 (23.8%) | 86 (30.7%) | 0.073 |
Arterial hypertension | 484 (82.9%) | 250 (82.2%) | 234 (83.6%) | 0.751 |
Smoking (former or present smoker) | 246 (42.3%) | 125 (41.5%) | 121 (43.2%) | 0.744 |
Hyperlipidemia | 410 (70.2%) | 217 (71.4%) | 193 (68.9%) | 0.578 |
Arterial vascular disease | 135 (23.1%) | 62 (20.4%) | 73 (26.1%) | 0.127 |
PAH (systolic > 60 mmHg) (n = 223) | 32 (14.3%) | 12 (11.1%) | 20 (17.4%) | 0.252 |
PAH (systolic > 40 mmHg) (n = 223) | 112 (50.2%) | 56 (51.9%) | 56 (48.7%) | 0.736 |
NYHA I/II
| 348 (59.6%) | 184 (60.5%) | 164 (58.6%) | 0.692 |
NYHA III/IV
| 236 (40.4%) | 120 (39.5%) | 116 (41.4%) | |
LVEF < 30% | 32 (5.5%) | 18 (6.0%) | 14 (5.0%) | 0.658 |
LVEF 30 to 50% | 139 (24.0%) | 68 (22.6%) | 71 (25.5%) | |
LVEF > 50% | 408 (70.5%) | 215 (71.4%) | 193 (69.4%) | |
ASA | 3 (3, 3) | 3 (3, 3) | 3 (3, 3) | 0.801 |
Add. EuroSCORE | 5 (5, 5) | 5 (5, 5) | 4 (5, 5) | 0.455 |
Add. EuroSCORE 0 to 2 | 134 (22.9%) | 63 (20.7%) | 71 (25.4%) | 0.300 |
Add. EuroSCORE 3 to 5 | 205 (35.1%) | 114 (37.5%) | 91 (32.5%) | |
Add. EuroSCORE > 5 | 245 (42.0%) | 127 (41.8%) | 118 (42.1%) | |
Other risk factors
| ||||
Pulmonary disease | 91(15.6%) | 46 (15.1%) | 45 (16.1%) | 0.843 |
Neurological disease | 70 (12.0%) | 36 (11.8%) | 34 (12.1%) | 0.988 |
Left main stem disease | 84 (14.4%) | 42 (13.8%) | 42 (15.0%) | 0.772 |
Previous cardiac or thoracic vascular surgery | 63 (10.8%) | 31 (10.2%) | 32 (11.4%) | 0.730 |
History of myocardial infarction | 132 (22.6%) | 80 (26.3%) | 52 (18.6%) | 0.033 |
Troponin-T positive status | 14 (2.4%) | 11 (3.6%) | 3 (1.1%) | 0.082 |
History of cardiogenic shock or acute decompensated heart failure | 71 (12.2%) | 32 (10.6%) | 39 (13.9%) | 0.278 |
Preoperative physiological profile
| ||||
MAP, mmHg | 97 (96, 98) | 98 (96, 100) | 96 (93, 99) | 0.305 |
Heart rate, bpm | 68 (67, 70) | 68.5 (67, 70) | 68 (67, 70) | 0.918 |
Mean ScO2room, % | 63 (62, 63) | 62 (62, 64) | 63 (62, 64) | 0.695 |
Mean ScO2ox, % | 68 (67, 68.17) | 68 (67, 69) | 68 (67, 69) | 0.926 |
ScO2minox, % | 66 (65, 67) | 66 (65, 67) | 65 (65, 67) | 0.924 |
NTproBNP, pg/ml (n = 389) | 455 (355, 519) | 392 (312, 496) | 517 (391, 686) | 0.234 |
hsTNT, pg/ml (n = 389) | 9 (8, 11) | 9 (8, 13) | 9 (7, 11) | 0.850 |
Total cohort | Control - no bicarbonate | Intervention - bicarbonate | Significance, P-value | |
---|---|---|---|---|
Number
| 584 | 304 (52.1%) | 280 (47.9%) | |
Type of procedure
| ||||
CABG | 222 (38.1) | 110 (36.3%) | 112 (40.0%) | 0.160 |
Valve surgery +/- varia | 176 (30.1%) | 93 (30.7%) | 82 (28.9%) | |
CABG +/- valve +/- varia | 120 (20.6%) | 71 (23.4%) | 49 (17.5%) | |
Aortic surgery +/- valve +/- varia | 54 (9.3%) | 21 (6.9%) | 33 (11.8%) | |
Various procedures | 10 (1.7%) | 8 (2.6%) | 3 (1.1%) | |
Aortic surgery +/- CABG | 2 (0.3%) | 1 (0.3%) | 1 (0.4%) | |
Duration of surgery, minutes
| 254 (247, 261) | 249 (242, 260) | 258 (250, 268) | 0.406 |
Duration of CPB, minutes
| 115 (110, 119) | 115 9 (107, 122) | 115 (109, 120) | 0.756 |
Crossclamp time, minutes
| 89.5 (84, 93) | 88.5 (82, 93) | 90 (83, 96) | 0.539 |
ECLS
| 7 (1.2%) | 3 (1.0%) | 4 (1.4%) | 0.913 |
IABP
| ||||
No IABP | 556 (95.2%) | 289 (95.1%) | 267 (95.4%) | 0.445 |
IABP before CPB | 6 (1.0%) | 2 (0.7%) | 4 (1.4%) | |
IABP during CPB | 8 (1.4%) | 6 (2.0%) | 2 (0.7%) | |
IABP after CPB | 8 (1.4%) | 3 (1.0%) | 5 (1.8%) | |
IABP on ICU | 6 (1.0%) | 4 (1.3%) | 2 (0.7%) | |
Circulatory arrest
| 21 (3.6%) | 13 (4.3%) | 8 (2.9%) | 0.485 |
Lowest body temperature, °C
| 32 (32, 32) | 32 (32, 32) | 32 (32, 32) | 0.615 |
Total cohort | Control - no bicarbonate | Intervention - bicarbonate | Significance, P-value | |
---|---|---|---|---|
Number
| 584 | 304 (52.1%) | 280 (47.9%) | |
Preoperative treatments
| ||||
Beta-blocking agents | 442 (75.8%) | 234 (77.0%) | 208 (74.6%) | 0.558 |
ACE-inhibitors/ARB | 424 (72.7%) | 225 (74.0%) | 199 (71.3%) | 0.526 |
Diuretics | 328 (56.4%) | 173 (56.9%) | 155 (55.8%) | 0.844 |
Vasodilators | 209 (35.8%) | 110 (36.2%) | 99 (35.5%) | 0.929 |
Phenprocoumon | 11 (1.9%) | 4 (1.3%) | 7 (2.5%) | 0.451 |
Aspirine | 373 (64.1%) | 203 (66.8%) | 170 (61.2%) | 0.185 |
Clopidogrel | 53 (9.1%) | 24 (7.9%) | 29 (10.4%) | 0.366 |
Heparin, intravenous | 95 (16.3%) | 62 (20.4%) | 33 (11.8%) | 0.007 |
Lipid-lowering drugs
| 356 (61.1%) | 197 (64.8%) | 159 (57.0%) | 0.065 |
Insulin | 64 (11.0%) | 30 (9.9%) | 34 (12.2%) | 0.446 |
Antibiotics | 64 (11.0%) | 33 (10.9%) | 31 (11.1%) | 0.973 |
Nitrates, intravenous | 29 (5.0%) | 17 (5.6%) | 12 (4.3%) | 0.599 |
Levosimendan | 16 (2.7%) | 7 (2.3%) | 9 (3.2%) | 0.669 |
Intraoperative fluids
| ||||
Cristalline fluids, ml | 1,948 (1,903, 1,993) | 1,982 (,1921, 2,042) | 1,911 (1,844, 1,978) | 0.120 |
Colloidal fluids, ml | 800 (756, 843) | 791 (730, 852) | 809 (748, 870) | 0.680 |
Postoperative fluids within 24 h
| ||||
Cristalline fluids, ml | 2,719 (2,667, 2,771) | 2,590 (2,519, 2661) | 2,859 (2,786, 2,933) | < 0.0001 |
Colloidal fluids, ml | 1,476 (1,412, 1,541) | 1,404 (1,314, 1,494) | 1,555(1,462, 1,647) | 0.022 |
Intraoperative blood transfusion
| ||||
PRC, patients transfused | 314 (53.8%) | 166 (54.6%) | 148 (52.9%) | 0.734 |
units transfused | 1 (0, 1) | 1 (0, 1) | 1 (0, 1) | 0.925 |
FFP, patients transfused | 38 (6.5%) | 20 (6.6%) | 18 (6.4%) | 0.925 |
units transfused | 0 [0-0] | 0 [0-0] | 0 [0-0] | 0.871 |
TC, patients transfused | 30 (5.1%) | 16 (5.3%) | 14 (5.0%) | 0.965 |
units transfused | 0 (0, 0) | 0 (0, 0) | 0 (0, 0) | 0.980 |
Cellsaver, number patients | 22 (3.8%) | 15 (4.9%) | 7 (2.5%) | 0.185 |
Postoperative blood transfusion
| ||||
PRC, patients transfused | 253 (43.3%) | 129 (42.4%) | 124 (44.3%) | 0.713 |
units transfused | 0.00 (0.00, 0.00) | 0.00 (0.00, 0.00) | 0.00 (0.00, 0.88) | 0.505 |
FFP, patients transfused | 43 (7.4%) | 22 (7.2%) | 21 (7.5%) | 0.971 |
units transfused | 0.00 (0.00, 0.00) | 0.00 (0.00, 0.00) | 0.00 (0.00, 0.00) | 0.907 |
TC, patients transfused | 43 (7.4%) | 22 (7.2%) | 21 (7.5%) | 0.980 |
units transfused | 0.00 (0.00, 0.00) | 0.00 (0.00, 0.00) | 0.00 (0.00, 0.00) | 0.881 |
Intraoperative vasoactive and inotropic treatments
| ||||
Levosimendan, n (%) | 24 (4.1%) | 11 (3.6%) | 13 (4.6%) | 0.679 |
Before CPB | 23 (3.9%) | 11 (3.6%) | 12 (4.3%) | 0.531 |
After CPB | 1 (0.2%) | 0 (0.0%) | 1 (0.4%) | |
Noradrenaline, n (%) | 522 (89.4%) | 268 (88.2%) | 254 (90.7%) | 0.386 |
< 0.3 mg/h | 261 (44.7%) | 148 (48.7%) | 113 (40.4%) | 0.069 |
0.3 to 0.6 mg/h | 187 (32.0%) | 87 (28.6%) | 100 (35.7%) | |
> 0.6 mg/h | 74 (12.7%) | 33 (10.9%) | 41 (14.6%) | |
Vasopressin, n (%) | 49 (8.4%) | 19 (6.2%) | 30 (10.7%) | 0.073 |
< 3 U/h | 33 (5.7%) | 11 (3.6%) | 22 (7.9%) | 0.109 |
3 to 6 U/h | 15 (2.6%) | 8 (2.6%) | 7 (2.5%) | |
> 6 U/h | 1 (0.2%) | 0 (0.0%) | 1 (0.4%) | |
Dobutamin, n (%) | 330 (56.5%) | 178 (58.6%) | 152 (54.3%) | 0.339 |
< 15 mg/h | 130 (22.3%) | 70 (23.0%) | 60 (21.4%) | 0.278 |
15 to 30 mg/h | 170 (29.1%) | 96 (31.6%) | 74 (26.4%) | |
> 30 mg/h | 30 (5.1%) | 12 (3.9%) | 18 (6.4%) | |
PDE-III inhibitors, n (%)
| 249 (42.6%) | 121 (39.8%) | 128 (45.7%) | 0.174 |
Low dose | 35 (6.0%) | 14 (4.6%) | 21 (7.5%) | 0.126 |
Moderate dose | 198 (33.9%) | 96 (31.6%) | 102 (36.4%) | |
High dose | 16 (2.7%) | 11 (3.6%) | 5 (1.8%) | |
Postoperative vasoactive and inotropic treatment, n (%)
| ||||
Levosimendan | 24 (4.1%) | 12 (3.9%) | 12 (4.3%) | 0.998 |
Noradrenalin | 494 (84.6%) | 246 (80.9%) | 248 (88.6%) | 0.015 |
< 0.3 mg/h | 262 (44.9%) | 147 (48.4%) | 115 (41.1%) | 0.0013 |
0.3 to 0.6 mg/h | 140 (24.0%) | 58 (19.1%) | 82 (29.3%) | |
> 0.6 mg/h | 92 (15.8%) | 41 (13.5%) | 51 (18.2%) | |
Vasopressin | 64 (11.0%) | 29 (9.5%) | 35 (12.5%) | 0.312 |
< 3 U/h | 49 (8.4%) | 19 (6.2%) | 30 (10.7%) | 0.116 |
3 to 6 Uh | 13 (2.2%) | 8 (2.6%) | 5 (1.8%) | |
> 6 U/h | 2 (0.3%) | 2 (0.7%) | 0 (0.0%) | |
Dobutamin | 386 (66.1%) | 207 (68.1%) | 179 (63.9%) | 0.330 |
< 15 mg/h | 184(31.5%) | 97 (31.9%) | 87 (31.1%) | 0.728 |
15 to 30 mg/h | 164 (28.1%) | 90 (29.6%) | 74 (26.4%) | |
> 30 mg/h | 38 (6.5%) | 20 (6.6%) | 18 (6.4%) | |
PDE III inhibitors | 312 (53.5%) | 156 (51.3%) | 156 (55.9%) | 0.304 |
Low dose | 60 (10.3%) | 32 (10.5%) | 28 (10.0%) | 0.665 |
Moderate dose | 224 (38.4%) | 110 (36.2%) | 114 (40.9%) | |
High dose | 28 (4.8%) | 14 (4.6%) | 14 (5.0%) |
Hemodynamics and metabolism
Total cohort | Control - no bicarbonate | Intervention - bicarbonate | Significance, P-value | |
---|---|---|---|---|
Number of patients
| 584 | 304 | 280 | |
HR, bpm, preoperative
| 68 (67, 70) | 68.5 (67, 70) | 68 (67, 70) | 0.875 |
MAP, mmHg, preoperative
| 96 (95, 98) | 97 (95, 100) | 95 (93, 97) | 0.396 |
MAP, mmHg, before induction
| 85 (82, 85) | 87 (85, 90) | 80 (76, 83) | < 0.0001 |
MAP, mmHg, 30 minutes before CPB
| 70 (70, 71) | 70 (70, 72) | 70 (68, 71) | 0.135 |
MAP, mmHg, 30 minutes after CPB
| 69 (68, 70) | 70 (69, 71) | 69 (67, 70) | 0.109 |
MAP, mmHg, end of surgery
| 72 (71, 73) | 73 (71, 74) | 71 (70, 73) | 0.150 |
MAP, mmHg, ICU admission
| 76 (75, 77) | 76 (75, 78) | 75 (73, 78) | 0.339 |
MAP, mmHg, 2 h after ICU admission
| 73 (72, 74) | 73 (71, 75) | 73 (72, 74) | 0.833 |
MAP, mmHg, 4 h after ICU admission
| 74 (72, 75) | 74 (72, 76) | 73 (72, 74) | 0.541 |
MAP, mmHg, 6 h after ICU admission
| 73 (73, 74) | 74 (73, 75) | 73 (72, 75) | 0.361 |
MAP, mmHg, 8 h after ICU admission
| 74 (73, 75) | 74 (72, 75) | 74 (72, 75) | 0.632 |
CVP, mmHg, after induction
| 11 (10, 11) | 11 (10, 11) | 11 (10, 12) | 0.340 |
CVP, mmHg, 30 minutes before CPB
| 8 (8, 8) | 8 (8, 9) | 8 (7, 9) | 0.561 |
CVP, mmHg, 30 minutes after CPB
| 11 (10, 11) | 10 (10, 11) | 11 (10, 12) | 0.663 |
CVP, mmHg, end of surgery
| 12 (11, 12) | 12 (11, 12) | 12 (11, 12) | 0.396 |
CVP, mmHg, ICU admission
| 15 (15, 16) | 16 (15, 16) | 15 (15, 16) | 0.689 |
CVP, mmHg, 2 h after ICU admission
| 15 (15, 16) | 16 (15, 16) | 15 (14, 15) | 0.129 |
CVP, mmHg, 4 h after ICU admission
| 15 (15, 16) | 15 (14, 16) | 15 (15, 16) | 0.425 |
CVP, mmHg, 6 h after ICU admission
| 14 (14, 15) | 14 (14, 15) | 14 (14, 15) | 0.358 |
CVP, mmHg, 8 h after ICU admission
| 13 (13, 14) | 13 (12, 14) | 13 (12, 14) | 0.801 |
MPAP, mmHg, After induction
| 25 (24, 27) | 26 (24, 29) n = 61 | 25 (22, 29) n = 46 | 0.380 |
MPAP, mmHg, 30 minutes after CPB
| 25 (23, 27) | 26 (23, 28) n = 76 | 25 (22, 27) n = 75 | 0.466 |
MPAP, mmHg, 30 minutes after CPB
| 26 (24, 27) | 25 (23, 28) n = 104 | 26 (24, 28) n = 97 | 0.324 |
MPAP, mmHg, end of surgery
| 26 (25, 28) | 26 (24, 28) n = 107 | 27 (24, 29) n = 94 | 0.659 |
MPAP, mmHg, ICU admission
| 29 (28, 30) | 30 (29, 33) n = 113 | 27 (26, 29) n = 84 | 0.006 |
MPAP, mmHg, 2 h after ICU admission
| 30 (29, 31) | 30 (29, 31) n = 120 | 29 (28, 31) n = 104 | 0.538 |
MPAP, mmHg, 4 h after ICU admission
| 30 (29, 31) | 31 (29, 32) n = 126 | 29 (28, 30) n = 107 | 0.448 |
MPAP, mmHg, 6 h after ICU admission
| 29 (27, 29) | 29 (27, 30) n = 125 | 28 (27, 30) n = 109 | 0.892 |
MPAP, mmHg, 8 h after ICU admission
| 28 (27, 29) | 28 (26, 30) n = 128 | 28 (26, 30) n = 113 | 0.731 |
CI, L/min/m2, after induction
| 2.45 (2.24, 2.66) | 2.46 (2.14, 2.77) n = 56 | 2.44 (2.17, 2.71) n = 38 | 0.947 |
CI, L/min/m2, 30 minutes before CPB
| 2.68 (2.57, 2.80) | 2.62 (2.45, 2.79) n = 76 | 2.75 (2.58, 2.92) n = 75 | 0.269 |
CI, L/min/m2, 30 minutes after CPB
| 3.22 (3.08, 3.37) | 3.14 (2.94, 3.34) n = 104 | 3.31 (3.09, 3.53) n = 97 | 0.261 |
CI, L/min/m2, end of surgery
| 3.02 (2.92-3.13) | 2.95 (2.79, 3.11) n = 107 | 3.11 (2.97, 3.25) n = 94 | 0.140 |
CI, L/min/m2, ICU admission
| 2.80 (2.69, 2.92) | 2.87 (2.73, 3.01) n = 113 | 2.71 (2.52, 2.89) n = 84 | 0.171 |
CI, L/min/m2, 2 h after ICU admission
| 3.06 (2.95, 3.17) | 3.07 (2.92, 3.22) n = 120 | 3.05 (2.88, 3.21) n = 104 | 0.835 |
CI, L/min/m2, 4 h after ICU admission
| 3.12 (3.02, 3.23) | 3.10 (2.98, 3.23) n = 126 | 3.15 (2.98, 3.32) n = 107 | 0.675 |
CI, L/min/m2, 6 h after ICU admission
| 3.24 (3.14, -3.35) | 3.22 (3.10, 3.34) n = 125 | 3.27 (3.08, 3.46) n = 109 | 0.686 |
CI, L/min/m2, 8 h after ICU admission
| 3.18 (3.09, 3.28) | 3.23 (3.11, 3.35) n = 128 | 3.13 (2.98, 3.28) n = 113 | 0.301 |
SvO
2
, %, after induction (n = 118)
| 79 (77, 80) | 79 (78, 81) n = 61 | 77 (75, 79) n = 46 | 0.060 |
SvO
2
, %, 30 minutes before CPB (n = 147)
| 82 (81, 82) | 82 (81, 83) n = 76 | 81 (80, 82) n = 75 | 0.357 |
SvO
2
, %, 30 minutes after CPB (n = 177)
| 78 (77, 79) | 79 (77, 80) n = 104 | 78 (77, 80) n = 97 | 0.735 |
SvO
2
, %, end of surgery (n = 179)
| 77 (76, 78) | 77 (76, 79) n = 107 | 77 (76, 79) n = 94 | 0.988 |
SvO
2
, %, ICU admission (n = 192)
| 71 (70, 72) | 71 (70, 73) n = 113 | 70 (68, 72) n = 84 | 0.380 |
SvO
2
, %, 2 h after ICU admission (n = 287)
| 69 (68, 70) | 69 (67, 70) n = 120 | 69 (67, 70) n = 104 | 0.931 |
SvO
2
, % 4 h after ICU admission (n = 309)
| 68 (67, 69) | 67 (66, 69) n = 126 | 68 (67, 69) n = 107 | 0.322 |
SvO
2
, %, 6 h after ICU admission (n = 316)
| 69 (68, 70) | 69 (68, 70) n = 125 | 69 (67, 70) n = 109 | 0.587 |
SvO
2
, %, 8 h after ICU admission
| 69 (68, 70) | 69 (68, 71) n = 128 | 69 (67, 70) n = 113 | 0.264 |
Total cohort | Control - no bicarbonate | Intervention - bicarbonate | Significance, P-value | |
---|---|---|---|---|
Number
|
584
|
304 (52.1%)
|
280 (47.9%)
| |
Diuresis and fluid balance
| ||||
Postoperative diuresis within 24 h, ml | 2,844 (2,744, 2,944) | 2,723 (2,564, 2,881) | 2,977 (2,861, 3,092) | 0.012 |
Postoperative cristalloid fluid balance, ml | -124 (-225, -22) | -133 (-295, 30) | -114 (-231, 4) | 0.855 |
Postoperative surgical drainage, ml | 927 (887, 968)] | 933 (875, 991) | 921 (865, 978) | 0.782 |
Postoperative colloidals - drainage fluid balance, ml | 549 (480, 618) | 471 (374, 569) | 633 (536, 731) | 0.022 |
Postoperative diuretics, number of patients
| ||||
Furosemide | 280 (47.9%) | 142 (46.7%) | 138 (49.3%) | 0.590 |
Torasemide | 462 (79.1%) | 242 (79.6%) | 220 (78.6%) | 0.838 |
HCT | 200 (34.2%) | 102 (33.6%) | 98 (35.0%) | 0.779 |
Other diuretics | 34 (5.8%) | 20 (6.6%) | 14 (5.0%) | 0.524 |
Renal function
| ||||
Creatinine baseline, μmol/L | 81 (79, 83) | 81 (78, 84) | 82 (78, 84) | 0.787 |
Creatinine maximum*, μmol/L | 93 (90, 96) | 93 (88, 97) | 93 (89, 97) | 0.785 |
Creatinine at discharge*, μmol/L | 82 (80, 87) | 84 (80, 88) | 80 (80, 87) | 0.153 |
Maximum relative increase in creatinine* | ||||
< 25% | 369 (63.2%) | 204 (67.1%) | 165 (58.9%) | 0.217 |
> 25% | 123 (21.1%) | 57 (18.8%) | 66 (23.6%) | |
> 50% | 56 (9.6%) | 25 (8.2%) | 31 (11.1%) | |
> 100% | 36 (6.2%) | 18 (5.9%) | 18 (6.4%) | |
eGFR baseline, ml/min | 82 (80, 84) | 81 (78, 84) | 83 (80, 87) | 0.434 |
eGFR minimum*, ml/min | 69 (67, 71) | 69 (66, 72) | 70 (66, 73) | 0.744 |
eGFR at discharge*, ml/min (n = 566) | 82 (79, 85) | 81 (77, 86) | 83 (79, 86) | 0.586 |
AKI grading according to creatinine changes (new RRT = grade 3), number patients | ||||
Grade 1 | 85 (14.6%) | 38 (12.5%) | 47 (16.8%) | 0.478 |
Grade 2 | 7 (1.2%) | 3 (1.0%) | 4 (1.4%) | |
Grade 3 | 74 (12.7%) | 39 (12.8%) | 35 (12.5%) | |
AKI grading according to diuresis** (new RRT = grade 3), number patients | ||||
Grade 1 | 14 (2.4%) | 11 (3.6%) | 3 (1.1%) | 0.135 |
Grade 2 | 1 (0.2%) | 0 (0.0%) | 1 (0.4%) | |
Grade 3 | 45 (7.7%) | 21 (6.9%) | 24 (8.6%) | |
AKI grading, total**, number patients | ||||
Grade 1 | 90 (15.4%) | 44 (14.5%) | 46 (16.4%) | 0.753 |
Grade 2 | 8 (1.4%) | 3 (1.0%) | 5 (1.8%) | |
Grade 3 | 75 (12.8%) | 39 (12.8%) | 36 (12.9%) | |
New RRT | ||||
Patients (%) | 45 (7.7%) | 22 (7.2%) | 23 (8.2%) | 0.774 |
Duration of treatment, h | 144 (114, 196) | 153 (110, 196) | 125 (76, 227) | 0.892 |
Intraoperative metabolism
| ||||
Blood glucose max, mg/dl | 193 (189, 202) | 189 (184, 193) | 197 (193, 204) | 0.005 |
Blood glucose min, mg/dl | 92 (91, 93) | 91.5 (89, 94) | 92 (91, 94) | 0.181 |
pH max | 7.45 (7.44, 7.45) | 7.45 (7.45, 7.45) | 7.45 (7.44, 7.45) | 0.034 |
pH min | 7.32 (7.32, 7.32) | 7.32 (7.31, 7.32) | 7.32 (7.32, 7.33) | 0.157 |
Lactate max, mmol/L | 1.7 (1.6, 1.8) | 1.6 (1.5, 1.7) | 1.8 (1.6, 1.9) | 0.005 |
Lactate min, mmol/L | 0.6 (0.6, 0.6) | 0.6 (0.6, 0.7) | 0.7 (0.6, 0.7) | 0.594 |
Postoperative metabolism
| ||||
Blood glucose max, mg/dl | 169.0 (166.0, 172.0) | 163.5 (161.0, 167.0) | 173.5 (170.12, 177.88) | 0.0015 |
Blood glucose min, mg/dl | 90.09 (88.68,1.51) | 89.70 (87.73, 91.67) | 90.53 (88.48, 92.57) | 0.566 |
pH max | 7.46 (7.46, 7.47] | 7.46 (7.45, 7.46) | 7.47 (7.46, 7.48) | 0.001 |
pH min | 7.32 (7.31, 7.32) | 7.32 (7.31, 7.32) | 7.32 (7.31, 7.33) | 0.165 |
Lactate max, mmol/L | 2.00 (1.90, 2.10) | 1.90 (1.70, 2.00) | 2.10 (2.00, 2.20) | 0.010 |
Intra- and postoperative treatments
Renal outcomes
General clinical outcomes
Total cohort | Control - no bicarbonate | Intervention - bicarbonate | Significance, P-value | |
---|---|---|---|---|
Number
| 584 | 304 (52.1%) | 280 (47.9%) | |
Postoperative ventilation time, h
| 7 (7, 7) | 7 (6, 8) | 7 (7, 8) | 0.234 |
Reintubation
| 46 (7.9%) | 22 (7.2%) | 24 (8.6%) | 0.648 |
Tracheostomy
| 18 (3.1%) | 8 (2.6%) | 11 (3.6%) | 0.677 |
Duration in ICU, h
| 23 (23, 24) | 23 (22, 24) | 24 (23, 24) | 0.093 |
Duration in IMC, h
| 38 (27, 43) | 27 (24, 42) | 44 (36, 48) | 0.0008 |
Duration in HDU, h
| 85 (73, 89) | 83 (71, 88) | 88 (72, 96) | 0.026 |
Re-admission to ICU
| 19 (3.3%) | 9 (3.0%) | 10 (3.6%) | 0.849 |
Need for CPR
| 10 (1.7%) | 6 (2.0%) | 4 (1.4%) | 0.851 |
Reoperation
| 80 (13.7%) | 45 (14.9%) | 35 (12.5%) | 0.492 |
MAC Score
| ||||
1 | 54 (9.2%) | 25 (8.2%) | 29 (10.4%) | 0.728 |
2 | 25 (4.3%) | 14 (4.6%) | 11 (3.9%) | |
3 | 10 (1.7%) | 5 (1.6%) | 5 (1.8%) | |
4 | 1 (0.2%) | 0 (0.0%) | 1 (0.4%) | |
Status upon discharge from hospital
| ||||
Extubated | 551 (94.3%) | 290 (95.4%) | 261 (93.2%) | 0.377 |
Intubated | 10 (1.7%) | 2 (0.7%) | 8 (2.9%) | |
Tracheostomy | 13 (2.2%) | 7 (2.3%) | 6 (2.1%) | |
Died in hospital | 8 (1.4%) | 4 (1.3%) | 4 (1.4%) | |
Status after 30 days
| ||||
Dead | 11 (1.9%) | 5 (1.6%) | 6 (2.1%) | 0.573 |
Alive | 572 (97.9%) | 298 (98.0%) | 274 (97.9%) | |
Unknown | 1 (0.2%) | 1 (0.3%) | 0 (0.0%) |
Discussion
Limitations
Conclusion
Key messages
-
The routine perioperative infusion of 4 mmol /Kg BW sodium failed to reduce the incidence of acute kidney injury and the need for renal replacement therapy in a heterogeneous cohort of cardiac surgical patients.
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Treatment with BIC was associated with hypotension, a higher need for vasopressors, and a prolonged stay in the HDU but had no other significant adverse effects on non-renal morbidity and 30-day mortality.