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Title: Sodium bicarbonate therapy for critically ill patients with metabolic acidosis: A scoping and a systematic review.
Austin Authors: Fujii, Tomoko;Udy, Andrew;Licari, Elisa;Romero, Lorena;Bellomo, Rinaldo 
Affiliation: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Department of Intensive Care, The Alfred, Melbourne, Victoria, Australia
The Ian Potter Library, The Alfred, Melbourne, Victoria, Australia
Department of Epidemiology and Preventive Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Japan Society for the Promotion of Science, Tokyo, Japan
School of Medicine, The University of Melbourne, Parkville, Melbourne, Victoria, Australia
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 26-Feb-2019
Date: 2019-06
Publication information: Journal of Critical Care 2019; 51: 184-191
Abstract: We aimed to assess the biochemical and physiological effects, clinical efficacy, and safety, of intravenous NaHCO3 therapy in critically ill patients with acute metabolic acidosis. We conducted a scoping review concerning the biochemical and physiological effects of NaHCO3 (PART A), and a systematic review regarding clinical efficacy (PART B). We searched MEDLINE in Part A and MEDLINE, EMBASE, Cochrane, the National Institute of Health Clinical Trials Register, and the WHOICTRP for randomised controlled trials in Part B. Twelve studies in Part A and two trials in Part B fulfilled the eligibility criteria. Intravenous NaHCO3 increased blood pH, base excess, serum bicarbonate, sodium, and PaCO2 during and after administration and decreased anion gap and potassium value. For clinical efficacy, only one study contributed to the effect estimate. The risk ratio (RR) for all-cause mortality was 0.83 (95% confidence interval, 0.68 to 1.02), and the risk of hypocalcaemia was increased in the bicarbonate group (RR 1.65, 95% confidence interval 1.09 to 2.50). There were inadequate data on hemodynamic indices. Given the lack of data on the effects of intravenous NaHCO3 therapy to support its clinical use and the frequency of bicarbonate therapy, a program of investigation appears justified.
DOI: 10.1016/j.jcrc.2019.02.027
ORCID: 0000-0002-1650-8939
Journal: Journal of Critical Care
PubMed URL: 30852347
Type: Journal Article
Subjects: Intensive care
Metabolic acidosis
Sodium bicarbonate
Systematic review
Appears in Collections:Journal articles

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