Systemic acidemia impairs cardiac function in critically Ill patients

Acidemia, is associated with reduced cardiac function in animals, but no studies showing an effect of acidemia on cardiac function in humans are reported. In the present study, we examined the effect of acidemia on cardiac function assessed with transpulmonary thermodilution technique with integrate...

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Published in:	EClinicalMedicine Vol. 37; p. 100956
Main Authors:	Rodríguez-Villar, S, Kraut, JA, Arévalo-Serrano, J, Sakka, SG, Harris, C, Awad, I, Toolan, M, Vanapalli, S, Collins, A, Spataru, A, Eiben, P, Recea, V, Brathwaite-Shirley, C, Thompson, L, Gurung, B, Reece-Anthony, R
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-07-2021 Elsevier
Subjects:	ABG-a Acidemia Acidosis Cardiac contractility Cardiac function CFI CPI Critical care dPmx GEF PiCCO Point-of-Care arterial blood gas Research Paper SVI Transpulmonary thermodilution CI SVI CFI Critical care ABG-a GEF CO Cardiac contractility PiCCO Acidemia Transpulmonary thermodilution Cardiac function Point-of-Care arterial blood gas pH dPmx Acidosis CPI
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Summary:	Acidemia, is associated with reduced cardiac function in animals, but no studies showing an effect of acidemia on cardiac function in humans are reported. In the present study, we examined the effect of acidemia on cardiac function assessed with transpulmonary thermodilution technique with integrated pulse contour analysis (Pulse Contour Cardiac Output, PiCCO™) in a large cohort of critically ill patients. This was a prospective multicenter observational cross-sectional study of 297 patients from 6 intensive care units in London, England selected from all patients admitted consecutively between May 2018 and March 2019. Measurements of lowest plasma pH and concurrent assessment of cardiac function were obtained. There was a significant difference between two pH categories (pH ≤ 7.28 vs. pH > 7.28) for the following variables of cardiac function: SVI (difference in means 32.7; 95% CI: 21 to 45 mL/m2; p < 0.001); GEF (18; 95% CI: 11 to 26%; p < 0.001), dPmax (-331; 95% CI: -510 to -153 mmHg/s; p = 0.001), CFI (0.7; 95% CI: 0.2 to 1.3 1/min; p = 0.01) and CPI (0.09; 95% CI: 0.03 to 0.15 W/m2; p < 0.001). However, there was no significant difference in CI (0.13; 95% CI: -0.20 to 0.47 L/min/m2; p = 0.12) between the pH categories. Also, a significant relationship was found between the quantitative pH and the following variables: SVI (132; 95% CI: 77 to 188 mL/m2; p < 0.001), GEF (74.7; 95% CI: 37.1 to 112.4%; p < 0.001), dPmax (-1587; 95% CI: -2361 to -815 mmHg/s; p < 0.001), CFI (3.5; 95% CI: 0.9 to 6.1 /min; p = 0.009), CPI (0.62; 95% CI: 0.36 to 0.88 W/m2; p < 0.001) and CI (regression coefficient 1.96; 95% CI:0.45 to 3.47 L/min/m2; p = 0.01). Acidemia is associated with impaired cardiac function in seriously ill patients hospitalized in the intensive care unit supporting the potential value of early diagnosis and improvement of arterial pH in these patients. The study was partially supported by unrestricted funds from the UCLA School of Medicine.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 These authors contributed equally to this work.
ISSN:	2589-5370 2589-5370
DOI:	10.1016/j.eclinm.2021.100956