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Waskowski J, Hess B, Cioccari L, et al. Effects of sodium bicarbonate infusion on mortality in medical-surgical ICU patients with metabolic acidosis-A single-center propensity score matched analysis. Med Intensiva (Engl Ed). 2021;doi: 10.1016/j.medin.2021.04.010.
Waskowski, J., Hess, B., Cioccari, L., Irincheeva, I., Pfortmueller, C. A., & Schefold, J. C. (2021). Effects of sodium bicarbonate infusion on mortality in medical-surgical ICU patients with metabolic acidosis-A single-center propensity score matched analysis. Medicina intensiva, . https://doi.org/10.1016/j.medin.2021.04.010
Waskowski, J, et al. "Effects of sodium bicarbonate infusion on mortality in medical-surgical ICU patients with metabolic acidosis-A single-center propensity score matched analysis." Medicina intensiva vol. (2021). doi: https://doi.org/10.1016/j.medin.2021.04.010
Waskowski J, Hess B, Cioccari L, Irincheeva I, Pfortmueller CA, Schefold JC. Effects of sodium bicarbonate infusion on mortality in medical-surgical ICU patients with metabolic acidosis-A single-center propensity score matched analysis. Med Intensiva (Engl Ed). 2021 Jun 10; doi: 10.1016/j.medin.2021.04.010. Epub 2021 Jun 10. Spanish. PMID: 34120787.
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Med Intensiva (Engl Ed). 2021 Jun 10; doi: 10.1016/j.medin.2021.04.010. Epub 2021 Jun 10.

Effects of sodium bicarbonate infusion on mortality in medical-surgical ICU patients with metabolic acidosis-A single-center propensity score matched analysis.

Medicina intensiva

[Article in Spanish]
J Waskowski, B Hess, L Cioccari, I Irincheeva, C A Pfortmueller, J C Schefold

Affiliations

  1. Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: [email protected].
  2. Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Center of Intensive Care Medicine, Luzerner Kantonsspital, Lucerne, Switzerland.
  3. Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  4. CTU Bern, University of Bern, Switzerland.

PMID: 34120787 DOI: 10.1016/j.medin.2021.04.010

Abstract

OBJECTIVE: Metabolic acidosis is associated with high mortality. Despite theoretical benefits of sodium-bicarbonate (SB), current evidence remains controversial. We investigated SB-related effects on outcomes in ICU patients with metabolic acidosis.

DESIGN: Retrospective analysis.

SETTING: Academic medical center.

PATIENTS OR PARTICIPANTS: 971 ICU patients with metabolic acidosis defined as arterial pH<7.3 and CO

INTERVENTIONS: 441 patients were treated with SB 8.4% (SB-group) and n=530 patients were not (control group).

MAIN VARIABLES OF INTEREST: Primary outcome was all-cause mortality at ICU-discharge. Average Treatment Effect (ATE), Average Treatment effect in Treated (ATT), and estimated relative survival effects at 20 days were computed.

RESULTS: In the full cohort, we observed considerable differences in pH, base excess, additional acidosis-related indices, and ICU mortality (controls 31% vs. SB-group 56%, p<.001) at baseline between the two groups. After PS-matching (n=174 in each group), no significant difference in ICU mortality was observed (controls 32% vs. SB-group 41%; p=.07). Odds ratios (OR) for ATE and ATT showed no association with ICU mortality (OR ATE: 1.08, 95%-CI 0.99-1.17; p=.08; OR ATT 1.09; 95%-CI 0.99-1.2; p=.09). Hazard ratios at 20-days (multivariable HR, matched sample n=348: 1.16, 95%-CI 0.86-1.56, p=.33) showed similar survival in the two study groups.

CONCLUSIONS: We did not observe effects of SB infusion on all-cause mortality in critically ill patients with metabolic acidosis.

Copyright © 2021 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.

Keywords: Acidosis metabólica; Bicarbonato de sodio; Critical illness; Enfermedad crítica; ICU; Metabolic acidosis; Mortalidad; Mortality; Sodium bicarbonate; UCI

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