Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/25797
Title: Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study.
Austin Authors: Fujii, Tomoko;Udy, Andrew A;Nichol, Alistair;Bellomo, Rinaldo ;Deane, Adam M;El-Khawas, Khaled;Naorungroj, Thummaporn ;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
Affiliation: Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland
Intensive Care
Centre for Integrated Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
Melbourne Medical School, Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
Department of Critical Care, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil
Intensive Care Unit, Royal Darwin Hospital, Darwin, NT, Australia
Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia
Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan
Department of Critical Care Medicine, Mackay Memorial Hospital Taipei Branch, Taipei, Taiwan
Division of Internal & Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
Melbourne Medical School, Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
Health Intelligence, Royal Melbourne Hospital, Parkville, VIC, Australia
Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
Intensive Care Unit, Peninsula Health, Frankston, VIC, Australia
Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan
Intensive Care Unit, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
Department of Critical Care Medicine, Mackay Memorial Hospital Taipei Branch, Taipei, Taiwan
Chung-Shan Medical University Hospital, Taichung, Taiwan
Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
Intensive Care Unit, Royal Darwin Hospital, Darwin, NT, Australia
Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan
Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
Division of Internal & Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
Chung-Shan Medical University Hospital, Taichung, Taiwan
Intensive Care Services, Eastern Health, Box Hill, VIC, Australia
Melbourne Medical School, Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia
Critical Care and Perioperative Services, Monash Health, Melbourne, VIC, Australia
Intensive Care Services, Eastern Health, Box Hill, VIC, Australia
Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
Intensive Care Unit, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
Critical Care Research, Monash Health School of Clinical Sciences, Monash University, Clayton, VIC, Australia
Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
Intensive Care Unit, Peninsula Health, Frankston, VIC, Australia
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan
Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Division of Internal & Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
Department of Internal Medicine, Park Branch, National Taiwan University Hospital Biomedical, Hsin-Chu, Taiwan
Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan
Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
Issue Date: 2021
Date: 2021
Publication information: Critical Care 2021; 25(1): 45
Abstract: 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. 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. 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. 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.
URI: https://ahro.austin.org.au/austinjspui/handle/1/25797
DOI: 10.1186/s13054-020-03431-2
ORCID: 0000-0003-3854-4081
Journal: Critical Care
PubMed URL: 33531020
Type: Journal Article
Subjects: Intensive care unit
Metabolic acidosis
Mortality
Observational study
Sodium bicarbonate
Vasopressor
Appears in Collections:Journal articles

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