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Published on: August 19, 2020
Acute serum sodium concentration changes in pediatric patients undergoing cardiopulmonary bypass and the association
Jeong Jin Lee1, Young-Soon Kim2, Hae Hyuk Jung3
1Department of Anaesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Insights
Serum sodium changes during pediatric heart surgery with cardiopulmonary bypass (CPB) are common. Preoperative hyponatremia and postoperative hypernatremia correlate with worse patient outcomes, necessitating careful sodium management.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Intensive Care Medicine
Background:
- Serum sodium levels fluctuate during pediatric heart surgery using cardiopulmonary bypass (CPB).
- Understanding these changes is crucial for optimizing patient outcomes.
Purpose of the Study:
- To investigate serum sodium level variations during CPB in pediatric patients.
- To determine the association between these sodium changes and patient outcomes.
Main Methods:
- Retrospective review of 275 pediatric patients undergoing heart surgery with CPB.
- Analysis of serum sodium levels before, during, and after CPB.
- Correlation of sodium levels with hospital stay and postoperative complications.
Main Results:
- Hyponatremia (≤135 mmol/L) was present pre-CPB in 21 patients.
- Severe hyponatremia (≤130 mmol/L) developed in 32 patients post-CPB initiation.
- Hypernatremia (≥145 mmol/L) occurred in 86 patients at CPB conclusion.
- Acute sodium changes during CPB were not linked to outcomes.
- Preoperative hyponatremia and postoperative hypernatremia were associated with longer hospital stays and higher complication rates.
- Lower preoperative and higher postoperative sodium levels, age, and operation duration independently predicted worse in-hospital outcomes.
Conclusions:
- Transient hyponatremia is frequent after CPB initiation, followed by a rise above baseline.
- Preoperative hyponatremia and postoperative hypernatremia are linked to adverse outcomes.
- Careful monitoring and avoidance of sodium overcorrection post-CPB are essential.
Abstract:
The objective of this study is to investigate the degree of serum sodium changes and its association with patient outcomes in pediatrics undergoing heart surgery with cardiopulmonary bypass (CPB). We reviewed the medical records of 275 pediatric patients who underwent heart surgery with CPB. Prior to CPB, hyponatremia (≤135 mmol/L) was observed in 21 of 275 patients. After initiation of CPB, serum sodium decreased significantly and severe hyponatermia (≤130 mmol/L) subsequently developed in 32 patients. At the end of CPB, however, hypernatremia (≥145 mmol/L) developed in 86 patients. The degree of acute serum sodium change during CPB was not associated with patient outcomes. However, the patients with preoperative hyponatremia and those with hypernatremia at the conclusion of CPB had longer hospital stays and higher postoperative complication rates. Lower serum sodium prior to CPB and higher serum sodium at the end of CPB, along with age and duration of the operation, were independently associated with worse in-hospital outcomes. Acute and transient hyponatremia occurred frequently after initiation of CPB, and then serum sodium immediately increased above preoperative levels at the end of CPB. Caution is required to avoid serum sodium overcorrection on the conclusion of CPB.
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