Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study

被引：28

作者：

Fujii, Tomoko ^{[1
,2
]}

Udy, Andrew A. ^{[1
,3
]}

Nichol, Alistair ^{[1
,3
,4
]}

Bellomo, Rinaldo ^{[1
,5
,6
]}

Deane, Adam M. ^{[7
]}

El-Khawas, Khaled ^{[3
]}

Thummaporn, Naorungroj ^{[5
,8
]}

Serpa Neto, Ary ^{[1
,5
,9
]}

Bergin, Hannah ^{[10
]}

Short-Burchell, Robert ^{[11
]}

Chen, Chin-Ming ^{[12
]}

Cheng, Kuang-Hua ^{[13
]}

Cheng, Kuo-Chen ^{[12
]}

Chia, Clemente ^{[3
]}

Chiang, Feng-Fan ^{[14
]}

Chou, Nai-Kuan ^{[15
]}

Fazio, Timothy ^{[7
,16
]}

Fu, Pin-Kuei ^{[15
]}

Ge, Victor ^{[17
]}

Hayashi, Yoshiro ^{[18
]}

Holmes, Jennifer ^{[19
]}

Hu, Ting-Yu ^{[13
]}

Huang, Shih-Feng ^{[20
]}

Iguchi, Naoya ^{[21
]}

Jones, Sarah L. ^{[10
]}

Karumai, Toshiyuki ^{[18
]}

Katayama, Shinshu ^{[22
]}

Ku, Shih-Chi ^{[23
]}

Lai, Chao-Lun ^{[24
]}

Lee, Bor-Jen ^{[14
]}

Liaw, Wen-Jinn ^{[20
]}

Ong, Chelsea T. W. ^{[25
]}

Paxton, Lisa ^{[7
]}

Peppin, Chloe ^{[26
]}

Roodenburg, Owen ^{[25
]}

Saito, Shinjiro ^{[2
]}

Santamaria, John D. ^{[19
]}

Shehabi, Yahya ^{[27
]}

Tanaka, Aiko ^{[21
]}

Tiruvoipati, Ravindranath ^{[1
,17
]}

Tsai, Hsiao-En ^{[24
]}

Wang, An-Yi ^{[28
,29
]}

Wang, Chen-Yu ^{[14
]}

Yeh, Yu-Chang ^{[30
]}

Yu, Chong-Jen ^{[31
,32
]}

Yuan, Kuo-Ching ^{[28
,29
]}

机构：

[1] Monash Univ, Australian & New Zealand Intens Care Res Ctr, Dept Epidemiol & Prevent Med, 553 St Kilda Rd, Melbourne, Vic 3004, Australia

[2] Jikei Univ Hosp, Intens Care Unit, Tokyo, Japan

[3] The Alfred, Dept Intens Care & Hyperbar Med, Melbourne, Vic, Australia

[4] Univ Coll Dublin, Sch Med & Med Sci, Dublin, Ireland

[5] Austin Hosp, Dept Intens Care, Heidelberg, Vic, Australia

[6] Univ Melbourne, Melbourne Med Sch, Ctr Integrated Crit Care, Melbourne, Vic, Australia

[7] Univ Melbourne, Royal Melbourne Hosp, Dept Med, Melbourne Med Sch, Parkville, Vic, Australia

[8] Mahidol Univ, Siriraj Hosp, Dept Crit Care, Bangkok, Thailand

[9] Hosp Israelita Albert Einstein, Dept Crit Care Med, Sao Paulo, Brazil

[10] Royal Darwin Hosp, Intens Care Unit, Darwin, NT, Australia

[11] Univ Hosp Geelong, Barwon Hlth, Intens Care Unit, Geelong, Vic, Australia

[12] Chi Mei Med Ctr, Dept Intens Care Med, Tainan, Taiwan

[13] Mackay Mem Hosp, Dept Crit Care Med, Taipei Branch, Taipei, Taiwan

[14] Taichung Vet Gen Hosp, Div Internal & Crit Care Med, Taichung, Taiwan

[15] Natl Taiwan Univ Hosp, Dept Surg, Taipei, Taiwan

[16] Royal Melbourne Hosp, Hlth Intelligence, Parkville, Vic, Australia

[17] Peninsula Hlth, Intens Care Unit, Frankston, Vic, Australia

[18] Kameda Med Ctr, Dept Intens Care Med, Chiba, Japan

[19] St Vincents Hosp Melbourne, Intens Care Unit, Fitzroy, Vic, Australia

[20] Chung Shan Med Univ Hosp, Taichung, Taiwan

[21] Osaka Univ, Grad Sch Med, Dept Anesthesiol & Intens Care Med, Osaka, Japan

[22] Jichi Med Univ, Sch Med, Dept Anesthesiol & Intens Care Med, Shimotsuke, Tochigi, Japan

[23] Natl Taiwan Univ Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Taipei, Taiwan

[24] Natl Taiwan Univ Hosp, Hsin Chu Branch, Dept Internal Med, Hsinchu, Taiwan

[25] Eastern Hlth, Intens Care Serv, Box Hill, Vic, Australia

[26] Monash Hlth, Crit Care & Perioperat Serv, Melbourne, Vic, Australia

[27] Monash Univ, Monash Hlth, Sch Clin Sci, Crit Care Res, Clayton, Vic, Australia

[28] Taipei Med Univ Hosp, Dept Crit Care Med, Taipei, Taiwan

[29] Taipei Med Univ, Coll Med, Sch Med, Dept Emergency Med, Taipei, Taiwan

[30] Natl Taiwan Univ Hosp, Dept Anesthesiol, Taipei, Taiwan

[31] Natl Taiwan Univ Hosp, Dept Internal Med, Taipei, Taiwan

[32] Natl Taiwan Univ Hosp Biomed, Pk Branch, Dept Internal Med, Hsinchu, Taiwan

来源：

CRITICAL CARE | 2021年 / 25卷 / 01期

关键词：

Metabolic acidosis; Sodium bicarbonate; Intensive care unit; Vasopressor; Mortality; Observational study; LACTIC-ACIDOSIS; DIABETIC-KETOACIDOSIS;

D O I：

10.1186/s13054-020-03431-2

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BackgroundMetabolic 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.MethodThis 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.ResultsWe 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.ConclusionsEarly 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.

引用

页数：10

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