Bicarbonate use and mortality outcome among critically ill patients with metabolic acidosis: A meta analysis |
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| Institution: | 1. Department of Medicine, Einstein Medical Center, Philadelphia, 5501 Old York Road, Philadelphia, PA 19141, United States;2. Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, United States;1. Department of Neurology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225000, China;2. Department of Cardiology, The Affiliated Hospital of Yangzhou University, No. 368, Hanjiang Road, Yangzhou, Jiangsu 225000, China;1. Oregon Health & Science University School of Nursing, SN-ORD, 3455 S.W. U.S. Veterans Hospital Road Portland, OR 97239-2941, USA;2. University of California Davis Betty Irene Moore School of Nursing, Sacramento, CA, USA;3. Providence Heart & Vascular Institute, Portland, OR, USA;4. Providence Sacred Heart Medical Center, Spokane, WA, USA;5. University of North Carolina, REX Healthcare, Raleigh, NC, USA;6. Boston College William F. Connell School of Nursing, Chestnut Hill, MA, USA;1. Radiology Department, University Hospital Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, United States;1. Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States;2. Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States;3. Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH, USA;4. Department of General Medicine, Gotri Medical Education and Research Center, Vadodara, Gujarat, India;1. Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA;2. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA;3. Department of Neurology, University of Washington, Seattle, WA, USA |
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| Abstract: | BackgroundThe use of sodium bicarbonate in the treatment of metabolic acidosis in critically ill subjects has long been a subject of debate. Despite empiric use in the setting of severe acidemia in critically ill patients, there is little data looking into the role of sodium bicarbonate in the treatment of severe metabolic acidosis in the intensive care unit (ICU) setting.MethodsWe conducted a comprehensive search of Pubmed and Cochrane Central Register of Controlled Trials addressing bicarbonate use in the metabolic acidosis in the intensive care unit (ICU) setting. We examined mortality as end point. Pooled odds ratios (OR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effect model.ResultsThe final search yielded 202 articles of which all were screened individually. A total of 11 studies were identified but 6 studies were excluded due to irrelevance in mortality outcome and methodology. Analysis was done separately for observational studies and randomized controlled trials. The pooled OR 95% CI] for mortality with bicarbonate use in the observational studies was 1.5 0.62–3.67] with heterogeneity of 67%, while pooled OR for mortality in the randomized trials was 0.72 0.49–1.05] (figure 2). In combining all studies, the pooled odds ratio was 0.93 95% 0.69–1.25] but with heterogeneity of 63%. After sensitivity analysis with removing the study done by Kim et al. 2013, heterogeneity was 0% with OR 0.8 0.59–1.10].ConclusionThere is no significant difference in mortality in the use of bicarbonate among critically ill patients with high anion gap metabolic acidosis predominantly driven by lactic acidosis. |
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