Sodium bicarbonate therapy for critically ill patients with metabolic acidosis: A scoping and a systematic review

被引:27
作者
Fujii, Tomoko [1 ,2 ,3 ]
Udy, Andrew [1 ,4 ]
Licari, Elisa [4 ]
Romero, Lorena [5 ]
Bellomo, Rinaldo [1 ,6 ,7 ]
机构
[1] Monash Univ, Dept Epidemiol & Prevent Med, Australian & New Zealand Intens Care Res Ctr, Melbourne, Vic, Australia
[2] Kyoto Univ, Grad Sch Med, Dept Epidemiol & Prevent Med, Kyoto, Japan
[3] Japan Soc Promot Sci, Tokyo, Japan
[4] The Alfred, Dept Intens Care, Melbourne, Vic, Australia
[5] The Alfred, Ian Potter Lib, Melbourne, Vic, Australia
[6] Austin Hosp, Dept Intens Care, Heidelberg, Vic, Australia
[7] Univ Melbourne, Sch Med, Melbourne, Vic, Australia
关键词
Metabolic acidosis; Sodium bicarbonate; Intensive care; Systematic review; HEART-ASSOCIATION GUIDELINES; HYPOXIC LACTIC-ACIDOSIS; ARTERIAL-BLOOD-GASES; CARDIOPULMONARY-RESUSCITATION; DIABETIC-KETOACIDOSIS; DOUBLE-BLIND; BASE; MANAGEMENT; HEMODYNAMICS; DISORDERS;
D O I
10.1016/j.jcrc.2019.02.027
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose: 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. Methods: 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. Results: 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. Conclusions: 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. (C) 2019 Elsevier Inc. All rights reserved.
引用
收藏
页码:184 / 191
页数:8
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