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Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study. / SODA-BIC investigators.

In: Critical care (London, England), Vol. 25, No. 1, 45, 12.2021, p. 45.

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SODA-BIC investigators. / Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study. In: Critical care (London, England). 2021 ; Vol. 25, No. 1. pp. 45.

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@article{7f5282ca163f45bea793c955e83a0a46,
title = "Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study",
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 PaCO 2, 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. [Figure not available: see fulltext.] ",
keywords = "Intensive care unit, Metabolic acidosis, Mortality, Observational study, Sodium bicarbonate, Vasopressor",
author = "Tomoko Fujii and Udy, {Andrew A.} and Alistair Nichol and Rinaldo Bellomo and Deane, {Adam M.} and Khaled el-Khawas and Naorungroj Thummaporn and {Serpa Neto}, Ary and Hannah Bergin and Robert Short-Burchell and Chin-Ming Chen and Kuang-Hua Cheng and Kuo-Chen Cheng and Clemente Chia and Feng-Fan Chiang and Nai-Kuan Chou and Timothy Fazio and Pin-Kuei Fu and Victor Ge and Yoshiro Hayashi and Jennifer Holmes and Ting-Yu Hu and Shih-Feng Huang and Naoya Iguchi and Jones, {Sarah L.} and Toshiyuki Karumai and Shinshu Katayama and Shih-Chi Ku and Chao-Lun Lai and Bor-Jen Lee and Wen-Jinn Liaw and Ong, {Chelsea T. W.} and Lisa Paxton and Chloe Peppin and Owen Roodenburg and Shinjiro Saito and Santamaria, {John D.} and Yahya Shehabi and Aiko Tanaka and Ravindranath Tiruvoipati and Hsiao-En Tsai and An-Yi Wang and Chen-Yu Wang and Yu-Chang Yeh and {SODA-BIC investigators} and Chong-Jen Yu and Kuo-Ching Yuan",
note = "Funding Information: This study was supported by Jikei University Research Grant to TF. The funding body did not take any role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Funding Information: SODA-BIC I investigators: ANZIC-RC, Victoria, Australia; Tomoko Fujii, Andrew A Udy, Adam M Deane, Alistair Nichol, Rinaldo Bellomo, Ary Serpa Neto. The Alfred, Victoria, Australia: Khaled El-Khawas, Andrew A Udy, Alistair Nichol. The Austin, Victoria, Australia; Naorungroj Thummaporn, Rinaldo Bellomo. The Royal Melbourne Hospital, Victoria, Australia: Lisa Paxton, Timothy Fazio, Adam M Deane. University Hospital Geelong, Victoria, Australia: Robert Short-Burchell, Allison Bone. Royal Darwin Hospital, Northern Territory, Australia: Hannah Bergin, Sarah Jones. St. Vincent?s Hospital, Victoria, Australia: Jennifer Holmes, John Santamaria. Monash Medical Centre, Victoria, Australia: Chloe Peppin, Yahya Shehabi. Frankston Hospital, Victoria, Australia: Ravindranath Tiruvoipati, Victor Ge, Lee-Anne Clavarino. Eastern Health, Victoria, Australia: Chelsea Ong, Owen Roodenburg, Steven Hirth. Osaka University Hospital, Osaka, Japan: Aiko Tanaka, Naoya Iguchi. Jichi University Hospital, Tochigi, Japan: Shinshu Katayama, Jun Shima, Fumie Takatsudo, Kumie Suzuki. Jikei University Hospital, Tokyo, Japan: Tomoko Fujii, Shinjiro Saito. Kameda Medical Centre, Chiba, Japan: Toshiyuki Karumai, Yoshiro Hayashi. National Taiwan University Hospital, Taipei, Taiwan: Yu-Chang Yeh, Chong-Jen Yu, Shih-Chi Ku, Nai-Kuan Chou. Mackay Memorial Hospital, Taipei, Taiwan: Ting-Yu Hu, Kuang-Hua Cheng. National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan: Chao-Lun Lai, Hsiao-En Tsai. Taipei Medical University Hospital, Taipei, Taiwan: Kuo-Ching Yuan, An-Yi Wang. Chung-Shan Medical University Hospital, Taichung, Taiwan: Shih-Feng Huang, Wen-Jinn Liaw. Chi-Mei Medical Centre, Tainan, Taiwan: Kuo-Chen Cheng, Chin-Ming Chen. Taichung Veterans General Hospital, Taichung, Taiwan: Bor-Jen Lee, Chen-Yu Wang, Feng-Fan Chiang, Pin-Kuei Fu. Publisher Copyright: {\textcopyright} 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",
year = "2021",
month = dec,
doi = "10.1186/s13054-020-03431-2",
language = "English",
volume = "25",
pages = "45",
journal = "Critical care (London, England)",
issn = "1364-8535",
publisher = "Springer Science + Business Media",
number = "1",

}

RIS

TY - JOUR

T1 - Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study

AU - Fujii, Tomoko

AU - Udy, Andrew A.

AU - Nichol, Alistair

AU - Bellomo, Rinaldo

AU - Deane, Adam M.

AU - el-Khawas, Khaled

AU - Thummaporn, Naorungroj

AU - Serpa Neto, Ary

AU - Bergin, Hannah

AU - Short-Burchell, Robert

AU - Chen, Chin-Ming

AU - Cheng, Kuang-Hua

AU - Cheng, Kuo-Chen

AU - Chia, Clemente

AU - Chiang, Feng-Fan

AU - Chou, Nai-Kuan

AU - Fazio, Timothy

AU - Fu, Pin-Kuei

AU - Ge, Victor

AU - Hayashi, Yoshiro

AU - Holmes, Jennifer

AU - Hu, Ting-Yu

AU - Huang, Shih-Feng

AU - Iguchi, Naoya

AU - Jones, Sarah L.

AU - Karumai, Toshiyuki

AU - Katayama, Shinshu

AU - Ku, Shih-Chi

AU - Lai, Chao-Lun

AU - Lee, Bor-Jen

AU - Liaw, Wen-Jinn

AU - Ong, Chelsea T. W.

AU - Paxton, Lisa

AU - Peppin, Chloe

AU - Roodenburg, Owen

AU - Saito, Shinjiro

AU - Santamaria, John D.

AU - Shehabi, Yahya

AU - Tanaka, Aiko

AU - Tiruvoipati, Ravindranath

AU - Tsai, Hsiao-En

AU - Wang, An-Yi

AU - Wang, Chen-Yu

AU - Yeh, Yu-Chang

AU - SODA-BIC investigators

AU - Yu, Chong-Jen

AU - Yuan, Kuo-Ching

N1 - Funding Information: This study was supported by Jikei University Research Grant to TF. The funding body did not take any role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. Funding Information: SODA-BIC I investigators: ANZIC-RC, Victoria, Australia; Tomoko Fujii, Andrew A Udy, Adam M Deane, Alistair Nichol, Rinaldo Bellomo, Ary Serpa Neto. The Alfred, Victoria, Australia: Khaled El-Khawas, Andrew A Udy, Alistair Nichol. The Austin, Victoria, Australia; Naorungroj Thummaporn, Rinaldo Bellomo. The Royal Melbourne Hospital, Victoria, Australia: Lisa Paxton, Timothy Fazio, Adam M Deane. University Hospital Geelong, Victoria, Australia: Robert Short-Burchell, Allison Bone. Royal Darwin Hospital, Northern Territory, Australia: Hannah Bergin, Sarah Jones. St. Vincent?s Hospital, Victoria, Australia: Jennifer Holmes, John Santamaria. Monash Medical Centre, Victoria, Australia: Chloe Peppin, Yahya Shehabi. Frankston Hospital, Victoria, Australia: Ravindranath Tiruvoipati, Victor Ge, Lee-Anne Clavarino. Eastern Health, Victoria, Australia: Chelsea Ong, Owen Roodenburg, Steven Hirth. Osaka University Hospital, Osaka, Japan: Aiko Tanaka, Naoya Iguchi. Jichi University Hospital, Tochigi, Japan: Shinshu Katayama, Jun Shima, Fumie Takatsudo, Kumie Suzuki. Jikei University Hospital, Tokyo, Japan: Tomoko Fujii, Shinjiro Saito. Kameda Medical Centre, Chiba, Japan: Toshiyuki Karumai, Yoshiro Hayashi. National Taiwan University Hospital, Taipei, Taiwan: Yu-Chang Yeh, Chong-Jen Yu, Shih-Chi Ku, Nai-Kuan Chou. Mackay Memorial Hospital, Taipei, Taiwan: Ting-Yu Hu, Kuang-Hua Cheng. National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan: Chao-Lun Lai, Hsiao-En Tsai. Taipei Medical University Hospital, Taipei, Taiwan: Kuo-Ching Yuan, An-Yi Wang. Chung-Shan Medical University Hospital, Taichung, Taiwan: Shih-Feng Huang, Wen-Jinn Liaw. Chi-Mei Medical Centre, Tainan, Taiwan: Kuo-Chen Cheng, Chin-Ming Chen. Taichung Veterans General Hospital, Taichung, Taiwan: Bor-Jen Lee, Chen-Yu Wang, Feng-Fan Chiang, Pin-Kuei Fu. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/12

Y1 - 2021/12

N2 - 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 PaCO 2, 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. [Figure not available: see fulltext.]

AB - 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 PaCO 2, 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. [Figure not available: see fulltext.]

KW - Intensive care unit

KW - Metabolic acidosis

KW - Mortality

KW - Observational study

KW - Sodium bicarbonate

KW - Vasopressor

UR - http://www.scopus.com/inward/record.url?scp=85101027357&partnerID=8YFLogxK

U2 - 10.1186/s13054-020-03431-2

DO - 10.1186/s13054-020-03431-2

M3 - Article

C2 - 33531020

VL - 25

SP - 45

JO - Critical care (London, England)

JF - Critical care (London, England)

SN - 1364-8535

IS - 1

M1 - 45

ER -

ID: 15869812