1. Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. a prospective, multiple-center study
- Author
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Laurent Muller, Laurent Papazian, Thomas Rimmelé, Boris Jung, Jean-Yves Lefrant, Christophe Guervilly, Gerald Chanques, Philippe Corne, Bernard Allaouchiche, Charlotte Le Goff, Samir Jaber, Olivier Jonquet, Passerieux, Emilie, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), CHU Marseille, Service d'anesthésie-réanimation [Centre Hospitalier Lyon Sud - HCL], Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), and Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
- Subjects
Male ,medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,Buffers ,Critical Care and Intensive Care Medicine ,Severity of Illness Index ,law.invention ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Patient Admission ,law ,medicine ,Humans ,Renal replacement therapy ,Prospective Studies ,Risk factor ,education ,Intensive care medicine ,Prospective cohort study ,Acidosis ,Aged ,education.field_of_study ,Sodium bicarbonate ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,business.industry ,Mortality rate ,Research ,Incidence ,nutritional and metabolic diseases ,030208 emergency & critical care medicine ,Proton Pump Inhibitors ,Middle Aged ,Prognosis ,Intensive care unit ,3. Good health ,Intensive Care Units ,Sodium Bicarbonate ,Treatment Outcome ,chemistry ,Emergency medicine ,Female ,medicine.symptom ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
International audience; Introduction: In this study, we sought describe the incidence and outcomes of severe metabolic or mixed acidemia in critically ill patients as well as the use of sodium bicarbonate therapy to treat these illnesses. Methods: We conducted a prospective, observational, multiple-center study. Consecutive patients who presented with severe acidemia, defined herein as plasma pH below 7.20, were screened. The incidence, sodium bicarbonate prescription and outcomes of either metabolic or mixed severe acidemia were analyzed. Results: Among 2, 550 critically ill patients, 200 (8%) presented with severe acidemia, and 155 (6% of the total admissions) met the inclusion criteria. Almost all patients needed mechanical ventilation and vasopressors during their ICU stay, and 20% of them required renal replacement therapy within the first 24 hours of their ICU stay. Severe metabolic or mixed acidemia was associated with a mortality rate of 57% in the ICU. Delay of acidemia recovery as opposed to initial pH value was associated with increased mortality in the ICU. The type of acidemia did not influence the decision to administer sodium bicarbonate. Conclusions: The incidence of severe metabolic or mixed acidemia in critically ill patients was 6% in the present study, and it was associated with a 57% mortality rate in the ICU. In contradistinction with the initial acid-base parameters, the rapidity of acidemia recovery was an independent risk factor for mortality. Sodium bicarbonate prescription was very heterogeneous between ICUs. Further studies assessing specific treatments may be of interest in this population.
- Published
- 2011