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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

Background: Corticosteroids are commonly used to treat COVID-19 patients with hypoxemia, and clinicians have adjusted the corticosteroid intensity on the basis of clinical needs. However, neither the optimal dose nor the duration of treatment has been recommended. Objective: To investigate whether cumulative doses of corticosteroids, measured as dexamethasone-equivalent doses over the first 14 days, impact outcomes in patients with COVID-19 pneumonia. Methods: We conducted a retrospective cohort study of COVID-19 pneumonia patients admitted between April 1st, 2020, and September 30th, 2021. The study focused on the type and dose of corticosteroid administered during the initial 14 days, clinical outcomes, and complications. The primary outcome was in-hospital mortality. Results: Among 271 patients, the mean cumulative dexamethasone-equivalent dose was 158 (119.9–197.25) mg in survivors and 185 (131.7–222.0) mg in nonsurvivors. Univariate analysis revealed that the cumulative dexamethasone-equivalent dose was a risk factor for in-hospital mortality. However, this association did not hold true in the multivariate analysis. After the cumulative dexamethasone-equivalent dose was categorized into quartiles, the moderate dosage (126.01–165.00 mg) in the second quartile was found to be associated with the lowest in-hospital mortality (16.2%). Higher cumulative dexamethasone-equivalent doses were associated with longer hospital and ICU stays and fewer ventilator-free days (p < 0.001). Doses exceeding 165 mg were associated with an increased risk of hospital-acquired infections (p < 0.001). Conclusions: The cumulative dexamethasone-equivalent dose during the first 14 days is not associated with in-hospital mortality in hypoxemic COVID-19 patients. However, higher cumulative doses exceeding 165 mg are associated with an increased risk of in-hospital mortality and secondary hospital-acquired infections. [ABSTRACT FROM AUTHOR]

Background: Both balanced crystalloid solution and normal saline are commonly used for fluid therapy in critically ill patients. However, the association between the types of crystalloid solution and patient outcomes remains inconclusive. Materials and Methods: The authors performed a search using Pubmed, Embase, and Cochrane Central Register through January 2022. Randomized controlled trials (RCTs) comparing balanced crystalloids and normal saline in non-perioperative fluid resuscitation for critically ill adult patients were included. The primary outcome was 30-day mortality. A trial sequential analysis (TSA) was performed to assess the effect of each type of fluid on the outcomes. Secondary outcomes included the incidence of acute kidney injury (AKI), renal replacement therapy (RRT), and other pre-specified outcomes. Results: Ten RCTs were identified and included 36,233 participants. Between the balanced crystalloids and the normal saline group, there were no significant differences in mortality at 30 days (relative risk [RR] 0.95, 95% confidence interval [CI] 0.89 to 1.02, I²=0), the incidence of AKI (RR 0.95, 95% CI 0.90 to 1.01, I²=0), and RRT (RR 0.93, 95% CI 0.86 to 1.01, I²=13). However, patients receiving balanced crystalloids demonstrated a significantly lower serum chloride level than the patients receiving normal saline (MD -1.95, 95% CI -3.45 to -0.45, I²=99). There was also no mortality difference in the sepsis and traumatic brain injury subgroups. The TSA confirmed the absence of an effect on mortality at 30 days and the incidence of AKI. Conclusion: In critically ill patients, the use of balanced crystalloids does not decrease 30-day mortality or the incidence of AKI and RRT. However, data in specific subgroups of patients were underpowered and further studies are required. There were signals of benefit and risk of the balanced salt solution in the subgroups of sepsis and traumatic brain injury. [ABSTRACT FROM AUTHOR]