Impact of slow infusion of sodium bicarbonate solution on hemodynamic resuscitation of patients following blood loss during surgery: A randomized controlled trial

Abstract Background: Maintaining systemic blood pressure and tissue perfusion in patients during hemorrhagic shock due to surgery is critical. In this study, the hemodynamic effects of bicarbonate infusion after hemorrhagic hypotension during surgery was investigated.Methods: This prospective clinical trial study was conducted on 59 candidates for total hip surgery at Sina hospital in 2020-2021. During surgery patients who had blood loss above 400 milliliters within 15 minutes and have systolic blood pressure (SBP) less than 90 mm Hg, randomly divided to bicarbonate(B) and control(C) groups. If bleeding reaches the maximum tolerable limit, in each group transfusion is started. At the end of operation an arterial blood sample is sent to measure blood gases and lactate level. Hemodynamic parameters, blood gas analysis and lactic acid changes before and after intervention was analyzed in each group. Results: A total number of 59 patients were analyzed. The SBP and mean arterial blood pressure in the B group increased after 10 minutes and remained higher than C group until 50 minutes of study. Also, the acid-base values in the B group maintained in the normal range in comparison with C group. Finally, the blood lactate level in B group was lower than the C group.Conclusions: In patients with hemorrhagic hypotension during surgery, the use of slow rate 7.5% sodium bicarbonate solution infusion along with other crystalloids can correct the patient's hypotension and metabolic acidosis compared to crystalloids alone.