Tomoko Fujii1,2, Andrew A Udy3,4, Alistair Nichol3,4,5, Rinaldo Bellomo3,6,7, Adam M Deane8, Khaled El-Khawas4, Naorungroj Thummaporn6,9, Ary Serpa Neto3,6,10, Hannah Bergin11, Robert Short-Burchell12, Chin-Ming Chen13, Kuang-Hua Cheng14, Kuo-Chen Cheng13, Clemente Chia4, Feng-Fan Chiang15, Nai-Kuan Chou16, Timothy Fazio8,17, Pin-Kuei Fu16, Victor Ge18, Yoshiro Hayashi19, Jennifer Holmes20, Ting-Yu Hu14, Shih-Feng Huang21, Naoya Iguchi22, Sarah L Jones11, Toshiyuki Karumai19, Shinshu Katayama23, Shih-Chi Ku24, Chao-Lun Lai25, Bor-Jen Lee15, Wen-Jinn Liaw21, Chelsea T W Ong26, Lisa Paxton8, Chloe Peppin27, Owen Roodenburg26, Shinjiro Saito28, John D Santamaria20, Yahya Shehabi29, Aiko Tanaka22, Ravindranath Tiruvoipati3,18, Hsiao-En Tsai25, An-Yi Wang30,31, Chen-Yu Wang15, Yu-Chang Yeh32, Chong-Jen Yu33,34, Kuo-Ching Yuan30,31. 1. Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia. tomoko.fujii@monash.edu. 2. Intensive Care Unit, Jikei University Hospital, Tokyo, Japan. tomoko.fujii@monash.edu. 3. Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia. 4. Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia. 5. School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland. 6. Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia. 7. Centre for Integrated Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia. 8. Melbourne Medical School, Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia. 9. Department of Critical Care, Siriraj Hospital, Mahidol University, Bangkok, Thailand. 10. Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil. 11. Intensive Care Unit, Royal Darwin Hospital, Darwin, NT, Australia. 12. Intensive Care Unit, University Hospital Geelong, Barwon Health, Geelong, VIC, Australia. 13. Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan. 14. Department of Critical Care Medicine, Mackay Memorial Hospital Taipei Branch, Taipei, Taiwan. 15. Division of Internal & Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. 16. Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. 17. Health Intelligence, Royal Melbourne Hospital, Parkville, VIC, Australia. 18. Intensive Care Unit, Peninsula Health, Frankston, VIC, Australia. 19. Department of Intensive Care Medicine, Kameda Medical Center, Chiba, Japan. 20. Intensive Care Unit, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia. 21. Chung-Shan Medical University Hospital, Taichung, Taiwan. 22. Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan. 23. Department of Anesthesiology and Intensive Care Medicine, Jichi Medical University School of Medicine, Tochigi, Japan. 24. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 25. Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan. 26. Intensive Care Services, Eastern Health, Box Hill, VIC, Australia. 27. Critical Care and Perioperative Services, Monash Health, Melbourne, VIC, Australia. 28. Intensive Care Unit, Jikei University Hospital, Tokyo, Japan. 29. Critical Care Research, Monash Health School of Clinical Sciences, Monash University, Clayton, VIC, Australia. 30. Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan. 31. Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 32. Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan. 33. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 34. Department of Internal Medicine, Park Branch, National Taiwan University Hospital Biomedical, Hsin-Chu, Taiwan.
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.
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 illpatients. 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.
Authors: Simona Humbel; Pedro David Wendel-Garcia; Simone Unseld; Fabienne Noll; Reto Andreas Schuepbach; Christoph Camille Ganter; Harald Seeger; Sascha David; Rea Andermatt Journal: J Clin Med Date: 2022-07-22 Impact factor: 4.964