ABSTRACT
pH management during cardiopulmonary bypass remains controversial. Both clinical and laboratory studies from Children’s Hospital have addressed this problem as it applies specifically to infants and neonates undergoing cardiopulmonary bypass and circulatory arrest. Advantages of the alpha-stat strategy include the preservation of flow/metabolism coupling, i.e., cerebral blood flow is appropriate for the degree of cerebral metabolism. At Boston Children’s Hospital, the pH-stat strategy was the standard method of pH management during hypothermic bypass until 1985. The following information was recorded regarding the postoperative period: hours of mechanical ventilation, days in the intensive care unit, days of hospitalization and presence or absence of seizures noted during routine clinical care by nurses, cardiovascular surgeons, or cardiologists. Evidence from both retrospective clinical studies and laboratory studies suggests that in the specific setting of infants undergoing deep hypothermic circulatory arrest with core cooling, the pH-stat strategy may provide more effective cerebral protection than the alpha-stat strategy.
