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Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study
- Source :
- Critical Care, Critical care (London, England), 25(1):45. Springer Science + Business Media, Critical Care, Vol 25, Iss 1, Pp 1-10 (2021)
- Publication Year :
- 2021
-
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 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.
- Subjects :
- Male
Internationality
Diabetic ketoacidosis
Bicarbonate
Taiwan
Critical Care and Intensive Care Medicine
law.invention
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Japan
law
Observational study
medicine
Humans
Intensive care unit
030212 general & internal medicine
Mortality
Acidosis
APACHE
Aged
Retrospective Studies
Sodium bicarbonate
business.industry
Metabolic acidosis
Research
Incidence
lcsh:Medical emergencies. Critical care. Intensive care. First aid
Australia
030208 emergency & critical care medicine
lcsh:RC86-88.9
Middle Aged
medicine.disease
Vasopressor
Intensive Care Units
chemistry
Lactic acidosis
Anesthesia
Base excess
Female
medicine.symptom
business
Subjects
Details
- Language :
- English
- ISSN :
- 13648535
- Volume :
- 25
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Critical care (London, England)
- Accession number :
- edsair.doi.dedup.....d06790f14d1cef1673abec8a5ebbc5e5