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Hypothermia induces metabolic and physicochemical changes that affect hydrogen ion concentration ([H\n                    <jats:sup>+<\/jats:sup>\n                    ]), haemoglobin\u2013dioxygen (O\n                    <jats:sub>2<\/jats:sub>\n                    ) binding, O\n                    <jats:sub>2<\/jats:sub>\n                    consumption, and carbon dioxide (CO\n                    <jats:sub>2<\/jats:sub>\n                    ) production. Modern blood gas analysers provide instantaneous measurements of blood pH, PO\n                    <jats:sub>2<\/jats:sub>\n                    , and PCO\n                    <jats:sub>2<\/jats:sub>\n                    , enabling rapid bedside assessment of acid\u2013base disturbances. Accurate interpretation, however, requires an understanding of the underlying physical and chemical principles. Acid\u2013base management during hypothermic CPB is typically guided by either a pH-stat (interpreting blood gases at the patient\u2019s actual temperature) or an alpha-stat strategy (interpreting blood gases at 37\u00b0C, independently of the patient\u2019s actual temperature). The optimal strategy remains debated. This review clarifies key physiological principles of acid\u2013base regulation, the effects of temperature on blood pH and gas solubility, and their clinical implications, with the aim of supporting accurate interpretation of blood gas values during hypothermic CPB.\n                  <\/jats:p>","DOI":"10.1177\/02676591261462292","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T04:36:26Z","timestamp":1782189386000},"page":"1364-1375","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hydrogen ion (pH) and gas behavior during deep hypothermic cardiopulmonary bypass: Physiology and clinical implications"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6846-8254","authenticated-orcid":false,"given":"Sylvain","family":"Diop","sequence":"first","affiliation":[{"name":"Marie Lannelongue Hospital"},{"name":"Marie Lannelongue Hospital"},{"name":"Marie Lannelongue Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Thes","sequence":"additional","affiliation":[{"name":"Marie Lannelongue Hospital"},{"name":"Marie Lannelongue Hospital"},{"name":"Marie Lannelongue Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Kassab","sequence":"additional","affiliation":[{"name":"Marie Lannelongue Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Mounier","sequence":"additional","affiliation":[{"name":"Avicenne Hospital"},{"name":"Universit\u00e9 Paris XIII"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"e_1_3_4_2_2","volume-title":"How to understand Acid-base: a quantitative acid-base primer for biology and medicine","author":"Stewart PA","year":"1981","unstructured":"Stewart PA. 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