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Differences in pH Management and Pulsatile/Nonpulsatile Perfusion During Cardiopulmonary Bypass Do Not Influence Renal Function

Department of Anaesthesia, University Hospital, University of Western Ontario, London, Ontario, Canada

The renal effects of pulsatile (pulse pressure 18.0 ± 1.5 mm Hg [mean ± SEM]) or nonpulsatile perfusion (mean pulse pressure 1.9 ± 0.4 mm Hg) during either -stat (mean PaC02 41.2 ± 0.9 mm Hg measured at 37°C) or pH-stat (mean PaC02 60.6 ± 1.7 mm Hg measured at 37°C) pH management of hypothermic cardiopulmonary bypass (CPB) were studied in 100 patients undergoing elective coronary artery bypass surgery. Mean urine output, fractional excretion of sodium and potassium, and renal failure index all increased during the study period; however, there was no difference among the four different CPB management groups. Mean postoperative creatinine and blood urea nitrogen values decreased compared with preoperative values, again without differences among treatment groups. Three patients developed acute renal insufficiency; of these, two had received nonpulsatile perfusion and pH-stat management, and the other had been managed with pulsatile perfusion and pH-stat management. These three patients all had undergone prolonged CPB and required at least two vasoactive drugs and the use of an intraaortic balloon pump to be weaned from CPB. In patients with normal preoperative renal function undergoing hypothermic CPB, neither the mode of perfusion, pulsatile or nonpulsatile, nor the method of pH management, pH-stat or -stat, influences perioperative renal function.

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