Observational Study

. 2021 Feb 2;25(1):45.

doi: 10.1186/s13054-020-03431-2.

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

Tomoko Fujii^{1

2}, Andrew A Udy^{3

4}, Alistair Nichol^{3

4

5}, Rinaldo Bellomo^{3

6

7}, Adam M Deane⁸, Khaled El-Khawas⁴, Naorungroj Thummaporn^{6

9}, Ary Serpa Neto^{3

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 Fazio^{8

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 Tiruvoipati^{3

18}, Hsiao-En Tsai²⁵, An-Yi Wang^{30

31}, Chen-Yu Wang¹⁵, Yu-Chang Yeh³², Chong-Jen Yu^{33

34}, Kuo-Ching Yuan^{30

31}; SODA-BIC investigators

Collaborators, Affiliations

Collaborators

SODA-BIC investigators:
Tomoko Fujii, Andrew A Udy, Adam M Deane, Alistair Nichol, Rinaldo Bellomo, Ary Serpa Neto, Khaled El-Khawas, Naorungroj Thummaporn, Lisa Paxton, Timothy Fazio, Robert Short-Burchell, Allison Bone, Hannah Bergin, Sarah Jones, Jennifer Holmes, John Santamaria, Chloe Peppin, Yahya Shehabi, Ravindranath Tiruvoipati, Victor Ge, Lee-Anne Clavarino, Chelsea Ong, Owen Roodenburg, Steven Hirth, Aiko Tanaka, Naoya Iguchi, Shinshu Katayama, Jun Shima, Fumie Takatsudo, Kumie Suzuki, Shinjiro Saito, Toshiyuki Karumai, Yoshiro Hayashi, Yu-Chang Yeh, Chong-Jen Yu, Shih-Chi Ku, Nai-Kuan Chou, Ting-Yu Hu, Kuang-Hua Cheng, Chao-Lun Lai, Hsiao-En Tsai, Kuo-Ching Yuan, An-Yi Wang, Shih-Feng Huang, Wen-Jinn Liaw, Kuo-Chen Cheng, Chin-Ming Chen, Bor-Jen Lee

Affiliations

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.

PMID: 33531020
PMCID: PMC7851901
DOI: 10.1186/s13054-020-03431-2

Observational Study

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

Tomoko Fujii et al. Crit Care. 2021.

. 2021 Feb 2;25(1):45.

doi: 10.1186/s13054-020-03431-2.

Authors

Collaborators

SODA-BIC investigators:
Tomoko Fujii, Andrew A Udy, Adam M Deane, Alistair Nichol, Rinaldo Bellomo, Ary Serpa Neto, Khaled El-Khawas, Naorungroj Thummaporn, Lisa Paxton, Timothy Fazio, Robert Short-Burchell, Allison Bone, Hannah Bergin, Sarah Jones, Jennifer Holmes, John Santamaria, Chloe Peppin, Yahya Shehabi, Ravindranath Tiruvoipati, Victor Ge, Lee-Anne Clavarino, Chelsea Ong, Owen Roodenburg, Steven Hirth, Aiko Tanaka, Naoya Iguchi, Shinshu Katayama, Jun Shima, Fumie Takatsudo, Kumie Suzuki, Shinjiro Saito, Toshiyuki Karumai, Yoshiro Hayashi, Yu-Chang Yeh, Chong-Jen Yu, Shih-Chi Ku, Nai-Kuan Chou, Ting-Yu Hu, Kuang-Hua Cheng, Chao-Lun Lai, Hsiao-En Tsai, Kuo-Ching Yuan, An-Yi Wang, Shih-Feng Huang, Wen-Jinn Liaw, Kuo-Chen Cheng, Chin-Ming Chen, Bor-Jen Lee

Affiliations

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.

PMID: 33531020
PMCID: PMC7851901
DOI: 10.1186/s13054-020-03431-2

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.

Keywords: Intensive care unit; Metabolic acidosis; Mortality; Observational study; Sodium bicarbonate; Vasopressor.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Trajectory of biochemical(a) or physiological(b) variables during the first 24 h of metabolic acidosis by treatment group. White box, No SB group. Gray box, SB group. P_NoSB denotes p for trend within patients who did not receive sodium bicarbonate for metabolic acidosis. P_SB, p for trend within patients who received sodium bicarbonate. P_int, p for interaction between treatment groups and the variables

See this image and copyright information in PMC

References

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

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources