Tomoko FujiiAndrew A. UdyAlistair NicholRinaldo BellomoAdam M. DeaneKhaled El-KhawasNaorungroj ThummapornAry Serpa NetoHannah BerginRobert Short-BurchellChin Ming ChenKuang Hua ChengKuo Chen ChengClemente ChiaFeng Fan ChiangNai Kuan ChouTimothy FazioPin Kuei FuVictor GeYoshiro HayashiJennifer HolmesTing Yu HuShih Feng HuangNaoya IguchiSarah L. JonesToshiyuki KarumaiShinshu KatayamaShih Chi KuChao Lun LaiBor Jen LeeWen Jinn LiawChelsea T.W. OngLisa PaxtonChloe PeppinOwen RoodenburgShinjiro SaitoJohn D. SantamariaYahya ShehabiAiko TanakaRavindranath TiruvoipatiHsiao En TsaiAn Yi WangChen Yu WangYu Chang YehChong Jen YuKuo Ching YuanAry Serpa NetoAllison BoneSarah JonesLee Anne ClavarinoSteven HirthJun ShimaFumie TakatsudoKumie SuzukiSchool of MedicineSiriraj HospitalGraduate School of MedicineMelbourne Medical SchoolJichi Medical UniversityChi Mei Medical CenterChung Shan Medical University HospitalNational Taiwan University HospitalKameda Medical CenterMackay Memorial Hospital TaiwanBarwon HealthMonash UniversityHospital Israelita Albert EinsteinFaculty of Medicine, Nursing and Health SciencesEastern HealthPeninsula HealthRoyal Darwin HospitalVeterans General Hospital-Taichung TaiwanRoyal Melbourne HospitalUniversity College DublinAustin HospitalTaipei Medical University HospitalSt. Vincent's Hospital MelbourneJikei University HospitalMonash Health2022-08-042022-08-042021-12-01Critical Care. Vol.25, No.1 (2021)1466609X136485352-s2.0-85101027357https://repository.li.mahidol.ac.th/handle/20.500.14594/77633Background: 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.]Mahidol UniversityMedicineArticleSCOPUS10.1186/s13054-020-03431-2