Sodium bicarbonate causes dose-dependent increases in cerebral blood flow in infants and children with single-ventricle physiology

Abstract

Background: Sodium bicarbonate (NaHCO 3) is a common treatment for metabolic acidemia; however, little definitive information exists regarding its treatment efficacy and cerebral hemodynamic effects. This pilot observational study quantifies relative changes in cerebral blood flow (ΔrCBF) and oxy-and deoxyhemoglobin concentrations (ΔHbO 2 and ΔHb) due to bolus administration of NaHCO 3 in patients with mild base deficits. Methods: Infants and children with hypoplastic left heart syndrome (HLHS) were enrolled before cardiac surgery. NaHCO 3 was given as needed for treatment of base deficit. Diffuse optical spectroscopies were used for 15 min postinjection to noninvasively monitor ΔHb, ΔHbO 2, and ΔrCBF relative to baseline before NaHCO 3 administration. Results: Twenty-two anesthetized and mechanically ventilated patients with HLHS (aged 1 d to 4 y) received a median (interquartile range) dose of 1.1 (0.8, 1.8) mEq/kg NaHCO 3 administered intravenously over 10-20 s to treat a median (interquartile range) base deficit of-4 (-6,-3) mEq/l. NaHCO 3 caused significant dose-dependent increases in ΔrCBF; however, population-averaged ΔHb and ΔHbO 2 as compared with those of controls were not significant.Conclusions:Dose-dependent increases in cerebral blood flow (CBF) caused by bolus administration of NaHCO 3 are an important consideration in vulnerable populations wherein risk of rapid CBF fluctuations does not outweigh the benefit of treating a base deficit. © 2013 International Pediatric Research Foundation, Inc.