{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T08:38:06Z","timestamp":1759826286183,"version":"3.43.0"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Metabolic alkalosis in pediatric patients following cardiac surgery warrants a comprehensive study. Newer methods of arterial blood gas (ABG) assessment can offer more insights into the mechanisms behind such derangement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective(s)<\/jats:title><jats:p>To study the incidence of metabolic alkalosis in postsurgical infants admitted to the pediatric cardiac intensive care unit and analyze factors associated with its development and its effect on prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Prospective observational study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary care teaching hospital in India during 2020\u20132021.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients<\/jats:title><jats:p>One hundred four infants &lt;\u20091\u2009year of age undergoing elective cardiac surgery and who required more than 6\u2009h of postoperative mechanical ventilation were included. Infants on preoperative mechanical ventilation or with metabolic alkalosis were excluded.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>Incidence of metabolic alkalosis and causative preoperative, intraoperative, and postoperative factors were studied along with their morbidity profile.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Metabolic alkalosis was detected in 23 (22.1%) subjects. In group MA (who developed metabolic alkalosis), 73.9% of infants belonged to risk adjustment for congenital heart surgery\u20101 (RACHS\u20101) category 3 and above (<jats:italic>p\u2009=<\/jats:italic>\u20090.009). They also had longer cardiopulmonary bypass time (200.04\u2009\u00b1\u200983.35\u2009min vs. 144.59\u2009\u00b1\u200964.77; 95% confidence interval of the difference in means [23, 87.9]), longer cross\u2010clamp time (119.78\u2009\u00b1\u200963.12\u2009min vs. 84.95\u2009\u00b1\u200948.8; 95% CI [10.4, 59.3]), greater application of modified ultrafiltration (MUF) (91.3% vs. 60.5%, <jats:italic>p\u2009=<\/jats:italic>\u20090.005), and larger volume of MUF removed (60 (44.4, 70)\u2009ml\u2009kg<jats:sup>\u22121<\/jats:sup> vs. 44.44 (32.9, 54.3), <jats:italic>p\u2009=<\/jats:italic>\u20090.003). Partitioning of base excess showed similar standard base excess due to free water (SBE<jats:sub>FW<\/jats:sub>) (MA \u22120.18\u2009\u00b1\u20090.94 vs. No MA 0.25\u2009\u00b1\u20091.1; confidence interval of the difference in means [\u22120.95, 0.09]) and due to chloride (SBE<jats:sub>Cl<\/jats:sub>) (MA \u22125.7\u2009\u00b1\u20094.8 vs. No MA \u22125.18\u2009\u00b1\u20095.05; 95% CI [\u22122.9, 1.8]) in both groups. A longer period of ventilation, intensive care unit stay, and hospital stay were found in group MA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This prospective study on postcardiotomy infants revealed a much lower incidence of metabolic alkalosis than historical data. Physicochemical analysis of the blood samples for mechanisms underlying metabolic alkalosis found that its development is not entirely dependent on overt volume depletion or significant chloride loss. The administration of chloride\u2010containing solutions appears to mitigate both the occurrence and severity of metabolic alkalosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.15104","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T06:12:55Z","timestamp":1743747175000},"page":"776-783","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Metabolic Alkalosis in the Pediatric Cardiac Intensive Care Unit\u2014A Prospective Observational Study"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5737-3818","authenticated-orcid":false,"given":"Diana","family":"Thomas","sequence":"first","affiliation":[{"name":"Division of Cardiothoracic and Vascular Anaesthesiology Amrita Institute of Medical Sciences  Kochi, Ernakulam Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suneel P.","family":"Raman","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic and Vascular Anaesthesiology Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baiju S.","family":"Dharan","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic and Vascular Surgery Sree Chitra Tirunal Institute for Medical Sciences and Technology  Thiruvananthapuram Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"issue":"2","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1186\/cc13802","article-title":"Metabolic Alkalosis Is the Most Common Acid\u2013Base Disorder in ICU Patients","volume":"18","author":"M\u00e6hle K.","year":"2014","journal-title":"Critical Care"},{"key":"e_1_2_9_3_1","first-page":"51","article-title":"Evaluation and Treatment of Alkalosis in Children","volume":"8","author":"Kopa\u010d M.","year":"2018","journal-title":"Journal of Pediatric Intensive Care"},{"issue":"2","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.ejcts.2005.04.013","article-title":"Metabolic Alkalosis After Pediatric Cardiac Surgery","volume":"28","author":"Thiel R. 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