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

Issued Date

2021-12-01

Resource Type

Article

ISSN

1466609X
13648535

DOI

10.1186/s13054-020-03431-2

Other identifier(s)

2-s2.0-85101027357

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Critical Care. Vol.25, No.1 (2021)

Suggested Citation

Tomoko Fujii, Andrew A. Udy, Alistair Nichol, Rinaldo Bellomo, Adam M. Deane, Khaled El-Khawas, Naorungroj Thummaporn, Ary Serpa Neto, Hannah Bergin, Robert Short-Burchell, Chin Ming Chen, Kuang Hua Cheng, Kuo Chen Cheng, Clemente Chia, Feng Fan Chiang, Nai Kuan Chou, Timothy Fazio, Pin Kuei Fu, Victor Ge, Yoshiro Hayashi, Jennifer Holmes, Ting Yu Hu, Shih Feng Huang, Naoya Iguchi, Sarah L. Jones, Toshiyuki Karumai, Shinshu Katayama, Shih Chi Ku, Chao Lun Lai, Bor Jen Lee, Wen Jinn Liaw, Chelsea T.W. Ong, Lisa Paxton, Chloe Peppin, Owen Roodenburg, Shinjiro Saito, John D. Santamaria, Yahya Shehabi, Aiko Tanaka, Ravindranath Tiruvoipati, Hsiao En Tsai, An Yi Wang, Chen Yu Wang, Yu Chang Yeh, Chong Jen Yu, Kuo Ching Yuan, Ary Serpa Neto, Allison Bone, Sarah Jones, Lee Anne Clavarino, Steven Hirth, Jun Shima, Fumie Takatsudo, Kumie Suzuki Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study. Critical Care. Vol.25, No.1 (2021). doi:10.1186/s13054-020-03431-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77633

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Title

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

Author(s)

Tomoko Fujii
 Andrew A. Udy
 Alistair Nichol
 Rinaldo Bellomo
 Adam M. Deane
 Khaled El-Khawas
 Naorungroj Thummaporn
 Ary Serpa Neto
 Hannah Bergin
 Robert Short-Burchell
 Chin Ming Chen
 Kuang Hua Cheng
 Kuo Chen Cheng
 Clemente Chia
 Feng Fan Chiang
 Nai Kuan Chou
 Timothy Fazio
 Pin Kuei Fu
 Victor Ge
 Yoshiro Hayashi
 Jennifer Holmes
 Ting Yu Hu
 Shih Feng Huang
 Naoya Iguchi
 Sarah L. Jones
 Toshiyuki Karumai
 Shinshu Katayama
 Shih Chi Ku
 Chao Lun Lai
 Bor Jen Lee
 Wen Jinn Liaw
 Chelsea T.W. Ong
 Lisa Paxton
 Chloe Peppin
 Owen Roodenburg
 Shinjiro Saito
 John D. Santamaria
 Yahya Shehabi
 Aiko Tanaka
 Ravindranath Tiruvoipati
 Hsiao En Tsai
 An Yi Wang
 Chen Yu Wang
 Yu Chang Yeh
 Chong Jen Yu
 Kuo Ching Yuan
 Ary Serpa Neto
 Allison Bone
 Sarah Jones
 Lee Anne Clavarino
 Steven Hirth
 Jun Shima
 Fumie Takatsudo
 Kumie Suzuki

Other Contributor(s)

School of Medicine
 Siriraj Hospital
 Graduate School of Medicine
 Melbourne Medical School
 Jichi Medical University
 Chi Mei Medical Center
 Chung Shan Medical University Hospital
 National Taiwan University Hospital
 Kameda Medical Center
 Mackay Memorial Hospital Taiwan
 Barwon Health
 Monash University
 Hospital Israelita Albert Einstein
 Faculty of Medicine, Nursing and Health Sciences
 Eastern Health
 Peninsula Health
 Royal Darwin Hospital
 Veterans General Hospital-Taichung Taiwan
 Royal Melbourne Hospital
 University College Dublin
 Austin Hospital
 Taipei Medical University Hospital
 St. Vincent's Hospital Melbourne
 Jikei University Hospital
 Monash Health

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 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. [Figure not available: see fulltext.]

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/77633

Collections

Scopus 2021