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Title: Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study.
Authors: Fujii, Tomoko
Udy, Andrew A
Nichol, Alistair
Bellomo, Rinaldo
Deane, Adam M
El-Khawas, Khaled
Thummaporn, Naorungroj
Serpa Neto, Ary
Bergin, Hannah
Short-Burchell, Robert
Chen, Chin-Ming
Cheng, Kuang-Hua
Cheng, Kuo-Chen
Chia, Clemente
Chiang, Feng-Fan
Chou, Nai-Kuan
Fazio, Timothy
Fu, Pin-Kuei
Ge, Victor
Hayashi, Yoshiro
Holmes, Jennifer
Hu, Ting-Yu
Huang, Shih-Feng
Iguchi, Naoya
Jones, Sarah L
Karumai, Toshiyuki
Katayama, Shinshu
Ku, Shih-Chi
Lai, Chao-Lun
Lee, Bor-Jen
Liaw, Wen-Jinn
Ong, Chelsea T W
Paxton, Lisa
Peppin, Chloe
Roodenburg, Owen
Saito, Shinjiro
Santamaria, John D
Shehabi, Yahya
Tanaka, Aiko
Tiruvoipati, Ravindranath
Tsai, Hsiao-En
Wang, An-Yi
Wang, Chen-Yu
Yeh, Yu-Chang
Yu, Chong-Jen
Yuan, Kuo-Ching
Citation: Crit Care. 2021 Feb 2;25(1):45. doi: 10.1186/s13054-020-03431-2.
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 < 7.3 and a Base Excess < -4 mEq/L, within 24-h of ICU admission) were included. Screening continued until 10 patients who received and 10 patients who did not receive sodium bicarbonate in the first 24 h (early bicarbonate therapy) were included at each site. The primary outcome was ICU mortality, and the association between sodium bicarbonate and the clinical outcomes were assessed using regression analysis with generalized linear mixed model. 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 PaCO(2), 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.
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Journal title: Critical care (London, England)
Volume: 25
Pages: 45
Publication Date: 2021-02-02
Type: Journal Article
Research Support, Non-U.S. Gov't
DOI: 10.1186/s13054-020-03431-2
Orcid: 0000-0003-3854-4081
Appears in Collections:(a) NT Health Research Collection

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