1. Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study
- Author
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Pin-Kuei Fu, Lisa Paxton, Chao-Lun Lai, Toshiyuki Karumai, Feng-Fan Chiang, Kuo-Ching Yuan, Shinshu Katayama, Yu-Chang Yeh, Adam M. Deane, Bor-Jen Lee, Robert J. Short-Burchell, Owen Roodenburg, Chen-Yu Wang, Chong-Jen Yu, Wen-Jinn Liaw, Shih-Feng Huang, Hannah Bergin, An-Yi Wang, Ting-Yu Hu, Andrew A. Udy, Ravindranath Tiruvoipati, Yoshiro Hayashi, Rinaldo Bellomo, Chelsea T. W. Ong, Timothy Fazio, Naorungroj Thummaporn, Chloe Peppin, Yahya Shehabi, Shih-Chi Ku, Jennifer Holmes, Chin-Ming Chen, Shinjiro Saito, John D. Santamaria, Hsiao-En Tsai, Kuo-Chen Cheng, Clemente Chia, Naoya Iguchi, Tomoko Fujii, Sarah Louise Jones, Aiko Tanaka, Alistair Nichol, Khaled El-Khawas, Ary Serpa Neto, Victor Ge, Kuang-Hua Cheng, Nai-Kuan Chou, investigators, SODA-BIC, and Intensive Care Medicine
- Subjects
Male ,Internationality ,Diabetic ketoacidosis ,Bicarbonate ,Taiwan ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Japan ,law ,Observational study ,medicine ,Humans ,Intensive care unit ,030212 general & internal medicine ,Mortality ,Acidosis ,APACHE ,Aged ,Retrospective Studies ,Sodium bicarbonate ,business.industry ,Metabolic acidosis ,Research ,Incidence ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Australia ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,Middle Aged ,medicine.disease ,Vasopressor ,Intensive Care Units ,chemistry ,Lactic acidosis ,Anesthesia ,Base excess ,Female ,medicine.symptom ,business - Abstract
Background Metabolic acidosis is a major complication of critical illness. However, its current epidemiology and its treatment with sodium bicarbonate given to correct metabolic acidosis in the ICU are poorly understood. Method This was an international retrospective observational study in 18 ICUs in Australia, Japan, and Taiwan. Adult patients were consecutively screened, and those with early metabolic acidosis (pH Results We screened 9437 patients. Of these, 1292 had early metabolic acidosis (14.0%). Early sodium bicarbonate was given to 18.0% (233/1292) of these patients. Dosing, physiological, and clinical outcome data were assessed in 360 patients. The median dose of sodium bicarbonate in the first 24 h was 110 mmol, which was not correlated with bodyweight or the severity of metabolic acidosis. Patients who received early sodium bicarbonate had higher APACHE III scores, lower pH, lower base excess, lower PaCO2, and a higher lactate and received higher doses of vasopressors. After adjusting for confounders, the early administration of sodium bicarbonate was associated with an adjusted odds ratio (aOR) of 0.85 (95% CI, 0.44 to 1.62) for ICU mortality. In patients with vasopressor dependency, early sodium bicarbonate was associated with higher mean arterial pressure at 6 h and an aOR of 0.52 (95% CI, 0.22 to 1.19) for ICU mortality. Conclusions Early metabolic acidosis is common in critically ill patients. Early sodium bicarbonate is administered by clinicians to more severely ill patients but without correction for weight or acidosis severity. Bicarbonate therapy in acidotic vasopressor-dependent patients may be beneficial and warrants further investigation.
- Published
- 2021