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Plasma acetate, gluconate and interleukin-6 profiles during and after cardiopulmonary bypass: a comparison of Plasma-Lyte 148 with a bicarbonate-balanced solution
- Source :
- Critical Care
- Publisher :
- Springer Nature
-
Abstract
- Introduction As even small concentrations of acetate in the plasma result in pro-inflammatory and cardiotoxic effects, it has been removed from renal replacement fluids. However, Plasma-Lyte 148 (Plasma-Lyte), an electrolyte replacement solution containing acetate plus gluconate is a common circuit prime for cardio-pulmonary bypass (CPB). No published data exist on the peak plasma acetate and gluconate concentrations resulting from the use of Plasma-Lyte 148 during CPB. Methods Thirty adult patients were systematically allocated 1:1 to CPB prime with either bicarbonate-balanced fluid (24 mmol/L bicarbonate) or Plasma-Lyte 148. Arterial blood acetate, gluconate and interleukin-6 (IL-6) levels were measured immediately before CPB (T1), three minutes after CPB commencement (T2), immediately before CPB separation (T3), and four hours post separation (T4). Results Acetate concentrations (normal 0.04 to 0.07 mmol/L) became markedly elevated at T2, where the Plasma-Lyte group (median 3.69, range (2.46 to 8.55)) exceeded the bicarbonate group (0.16 (0.02 to 3.49), P < 0.0005). At T3, levels had declined but the differential pattern remained apparent (Plasma-Lyte 0.35 (0.00 to 1.84) versus bicarbonate 0.17 (0.00 to 0.81)). Normal circulating acetate concentrations were not restored until T4. Similar gluconate concentration profiles and inter-group differences were seen, with a slower T3 decay. IL-6 increased across CPB, peaking at T4, with no clear difference between groups. Conclusions Use of acetate containing prime solutions result in supraphysiological plasma concentrations of acetate. The use of acetate-free prime fluid in CPB significantly reduced but did not eliminate large acetate surges in cardiac surgical patients. Complete elimination of acetate surges would require the use of acetate free bolus fluids and cardioplegia solutions. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000267055
- Subjects :
- Male
medicine.medical_specialty
Time Factors
Sodium Acetate
Bicarbonate
Potassium
Sodium
Magnesium Chloride
chemistry.chemical_element
bicarbonate
gluconate sodium
Acetates
Sodium Chloride
Critical Care and Intensive Care Medicine
Gluconates
law.invention
Potassium Chloride
chemistry.chemical_compound
Intraoperative Period
Bolus (medicine)
law
Internal medicine
medicine
Cardiopulmonary bypass
Humans
Postoperative Period
Aged
Cardiopulmonary Bypass
business.industry
Interleukin-6
Research
Middle Aged
Bicarbonates
acetic acid
Endocrinology
Treatment Outcome
chemistry
Anesthesia
Arterial blood
Female
Isotonic Solutions
business
Sodium acetate
Blood sampling
Subjects
Details
- Language :
- English
- ISSN :
- 13648535
- Volume :
- 15
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Critical Care
- Accession number :
- edsair.doi.dedup.....4efb0b9485f8ddf90e21898a21a2ae47
- Full Text :
- https://doi.org/10.1186/cc9966