Sodium bicarbonate therapy for critically ill patients with metabolic acidosis: A scoping and a systematic review.

Lorena Romero, Tomoko Fujii, Andrew Udy, Elisa Licari, Rinaldo Bellomo

Journal: Journal of critical care 2020;51():184-191

PMID: 30852347

Full Text on Elsevier Science View on PubMed

Abstract

PURPOSE

We aimed to assess the biochemical and physiological effects, clinical efficacy, and safety, of intravenous NaHCO3 therapy in critically ill patients with acute metabolic acidosis.

METHODS

We conducted a scoping review concerning the biochemical and physiological effects of NaHCO3 (PART A), and a systematic review regarding clinical efficacy (PART B). We searched MEDLINE in Part A and MEDLINE, EMBASE, Cochrane, the National Institute of Health Clinical Trials Register, and the WHOICTRP for randomised controlled trials in Part B.

RESULTS

Twelve studies in Part A and two trials in Part B fulfilled the eligibility criteria. Intravenous NaHCO3 increased blood pH, base excess, serum bicarbonate, sodium, and PaCO2 during and after administration and decreased anion gap and potassium value. For clinical efficacy, only one study contributed to the effect estimate. The risk ratio (RR) for all-cause mortality was 0.83 (95% confidence interval, 0.68 to 1.02), and the risk of hypocalcaemia was increased in the bicarbonate group (RR 1.65, 95% confidence interval 1.09 to 2.50). There were inadequate data on hemodynamic indices.

CONCLUSIONS

Given the lack of data on the effects of intravenous NaHCO3 therapy to support its clinical use and the frequency of bicarbonate therapy, a program of investigation appears justified.

Address: Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; Japan Society for the Promotion of Science, Tokyo, Japan. Electronic address: [email protected].; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, The Alfred, Melbourne, VIC, Australia.; Department of Intensive Care, The Alfred, Melbourne, VIC, Australia.; The Ian Potter Library, The Alfred, Melbourne, VIC, Australia.; Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Intensive Care, Austin Hospital, Heidelberg, VIC, Australia; School of Medicine, The University of Melbourne, Parkville, Melbourne, VIC, Australia.

DOI: 10.1016/j.jcrc.2019.02.027

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MeSH Terms: Acidosis, Beryllium, Critical Illness, Humans, Potassium, Sodium, Sodium Bicarbonate, Treatment Outcome