In this episode, I’ll discuss sodium bicarbonate to treat metabolic acidosis in ICU patients.
Sodium Bicarbonate is frequently given to ICU patients to correct metabolic acidosis however, evidence to support this indication has been lacking and sodium bicarb is not a benign intervention without risk of adverse effects.
Back in episode 835, I discussed a pilot trial of 30 ICU patients with metabolic acidosis that were given either sodium bicarbonate or a placebo, which appeared to have some positive results. Now, in the journal Intensive Care Medicine, we have a retrospective target trial emulation looking at sodium bicarbonate administration for metabolic acidosis in the intensive care unit.
Retrospective data from 12 Australian ICUs were used for this study. Inclusion criteria were adults with pH < 7.3 and PCO2 ≤ 45 mmHg within the first three days of ICU stay.
The treatment intervention was sodium-bicarbonate administration, and the primary outcome was 30-day ICU mortality with ICU discharge as a competing event. Multiple subgroups were also analyzed.
The authors found that using sodium bicarbonate was associated with a 1.9% absolute mortality reduction for the primary outcome of 30-day ICU mortality with a risk ratio of 0.86.
Additionally, significant benefits were seen across all subgroups evaluated. A similar point estimate of 2.1% was observed in the sensitivity analysis, with a sustained mortality reduction seen at 30 days.
The authors concluded:
In this target trial emulation, bicarbonate administration was associated with a small but statistically significant reduction in mortality for patients with metabolic acidosis. Large sample sizes would be required to demonstrate this effect in a randomized trial.
While not at the same level of evidence as a prospective randomized trial, a target trial emulation does eliminate many of the potential biases in retrospective research. This study suggests that sodium bicarbonate for metabolic acidosis in critically ill patients may indeed have a clinically meaningful impact on patient outcomes.
The article in this episode is a selection from my Hospital Pharmacy Academy’s weekly literature digest. Have you ever felt like your physician colleagues are one step ahead of you with new literature developments? Every week, Academy members are provided a summary curated and explained by me of the top hospital pharmacy-related articles published that week from over 20 major journals and sources to save you time and keep you up to date with the literature. To get immediate access, go to pharmacyjoe.com/academy.
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