• Tomoko Fujii, Andrew A Udy, Alistair Nichol, Rinaldo Bellomo, Adam M Deane, Khaled El-Khawas, Naorungroj Thummaporn, Ary Serpa Neto, Hannah Bergin, Robert Short-Burchell, Chin-Ming Chen, Kuang-Hua Cheng, Kuo-Chen Cheng, Clemente Chia, Feng-Fan Chiang, Nai-Kuan Chou, Timothy Fazio, Pin-Kuei Fu, Victor Ge, Yoshiro Hayashi, Jennifer Holmes, Ting-Yu Hu, Shih-Feng Huang, Naoya Iguchi, Sarah L Jones, Toshiyuki Karumai, Shinshu Katayama, Shih-Chi Ku, Chao-Lun Lai, Bor-Jen Lee, Wen-Jinn Liaw, Chelsea T W Ong, Lisa Paxton, Chloe Peppin, Owen Roodenburg, Shinjiro Saito, John D Santamaria, Yahya Shehabi, Aiko Tanaka, Ravindranath Tiruvoipati, Hsiao-En Tsai, An-Yi Wang, Chen-Yu Wang, Yu-Chang Yeh, Chong-Jen Yu, Kuo-Ching Yuan, and SODA-BIC investigators.
• 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.
• Crit Care. 2021 Feb 2; 25 (1): 45.

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.

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