Dataset Information

Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study.

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?ResultsWe 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.

SUBMITTER: Fujii T

PROVIDER: S-EPMC7851901 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study.

Fujii Tomoko T Udy Andrew A AA Nichol Alistair A Bellomo Rinaldo R Deane Adam M AM El-Khawas Khaled K Thummaporn Naorungroj N Serpa Neto Ary A Bergin Hannah H Short-Burchell Robert R Chen Chin-Ming CM Cheng Kuang-Hua KH Cheng Kuo-Chen KC Chia Clemente C Chiang Feng-Fan FF Chou Nai-Kuan NK Fazio Timothy T Fu Pin-Kuei PK Ge Victor V Hayashi Yoshiro Y Holmes Jennifer J Hu Ting-Yu TY Huang Shih-Feng SF Iguchi Naoya N Jones Sarah L SL Karumai Toshiyuki T Katayama Shinshu S Ku Shih-Chi SC Lai Chao-Lun CL Lee Bor-Jen BJ Liaw Wen-Jinn WJ Ong Chelsea T W CTW Paxton Lisa L Peppin Chloe C Roodenburg Owen O Saito Shinjiro S Santamaria John D JD Shehabi Yahya Y Tanaka Aiko A Tiruvoipati Ravindranath R Tsai Hsiao-En HE Wang An-Yi AY Wang Chen-Yu CY Yeh Yu-Chang YC Yu Chong-Jen CJ Yuan Kuo-Ching KC

Critical care (London, England) 20210202 1

<h4>Background</h4>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.<h4>Method</h4>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 < 7.3 and a Base Excess < -4 mEq/L, within 24-h of ICU admission) ...[more]

PMID: 33531020

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Dataset Information

Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study.

Background

Method

Conclusions

Publications

Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study.

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