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

• Published in: Journal of critical care 2019-06, Vol.51, p.184-191
• Main Authors: Fujii, Tomoko, Udy, Andrew, Licari, Elisa, Romero, Lorena, Bellomo, Rinaldo
• Format: Article
• Language: English
• Subjects: Acidosis; Acidosis - drug therapy; Acidosis - mortality; Beryllium - blood; Carbon dioxide; Clinical trials; Collaboration; Critical care; Critical Illness - therapy; Evidence-based medicine; Heart surgery; Humans; Intensive care; Metabolic acidosis; Metabolic disorders; Metabolism; Mortality; Patients; Physiology; Plasma; Potassium - blood; Sodium; Sodium - blood; Sodium bicarbonate; Sodium Bicarbonate - therapeutic use; Systematic review; Treatment Outcome
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2019.02.027

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. 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. 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. 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. •Acute metabolic acidosis is common in ICU patients, and NaHCO3 is frequently used.•We conducted a scoping review and a systematic review to assess the effects.•NaHCO3 increased blood pH, BE, serum HCO3, Na, PaCO2, and decreased AG and K.•Only one study reported the effect on mortality (RR 0.83, low certainty of evidence).•Investigation of the effects on NaHCO3 appears justified.