• Ary Serpa Neto, Ahmad Nasser, Prashanti Marella, Tomoko Fujii, Kazunari Takahashi, Kevin Laupland, Alexis Tabah, Antony G Attokaran, Aashish Kumar, James McCullough, Kiran Shekar, Peter Garrett, Sebastiaan Blank, Siva Senthuran, Stephen Luke, Mairead McNamara, Rinaldo Bellomo, Kyle White, and Queensland Critical Care Research Network (QCCRN) and the SODa-BIC investigators.
• Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Level 3 553 St Kilda Road, Melbourne, VIC 3004, Australia; Department of Intensive Care, Austin Hospital, 145 Studley Rd, Heidelberg, VIC 3084, Australia; Department of Critical Care, Melbourne Medical School, University of Melbourne, Austin Hospital, 157-159 Barry Street, Parkville, VIC 3010, Australia; Department of Critical Care Medicine, Av. Albert Einstein, 627/701, Morumbi, São Paulo, SP 05652-900, Brazil.
• J Crit Care. 2025 Feb 1; 85: 154936154936.

PurposeClinical trials focusing on critically ill patients with metabolic acidosis, a common exclusion criterion is the presence of a PaCO2 > 45 mmHg. The aim of this study was to assess the impact of mild hypercapnia on patient characteristics, severity, and clinical outcomes in critically ill patients with metabolic acidosis.Material And MethodsMulticentre, retrospective, observational study conducted in 12 intensive care units (ICUs) in Queensland, Australia. Patients with metabolic acidosis and concurrent vasopressor requirement were included and the exposure of interest was the PaCO2 level at the time of meeting the eligibility criteria divided in two groups: PaCO2 ≤ 45 mmHg and PaCO2 46-50 mmHg. Primary clinical outcome was major adverse kidney events within 30 days (MAKE30).ResultsWe studied 5601 patients, with 3605 (64.4 %) in the PaCO2 ≤ 45 mmHg group and 1996 (35.6 %) in the PaCO2 46-50 mmHg group. The incidence of MAKE30 was lower in the PaCO2 46-50 mmHg group (29 % vs. 34 %; OR, 0.79 [95 %CI, 0.69 to 0.90]; p < 0.001) as was the use of renal replacement therapy, and the incidence of acute kidney injury. After adjustment for confounders, no outcome was different between the groups. The maximum fall of pH associated with an increase of 1 mmHg of PaCO2 in the PaCO2 46-50 mmHg group was 0.006.ConclusionIn patients with metabolic acidosis, after adjustment for potential confounders, mild hypercapnia does not increase the MAKE-30 rate and does not have a major impact on pH.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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