Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. a prospective, multiple-center study

Abstract

IntroductionIn this study, we sought describe the incidence and outcomes of severe metabolic or mixed acidemia in critically ill patients as well as the use of sodium bicarbonate therapy to treat these illnesses.MethodsWe conducted a prospective, observational, multiple-center study. Consecutive patients who presented with severe acidemia, defined herein as plasma pH below 7.20, were screened. The incidence, sodium bicarbonate prescription and outcomes of either metabolic or mixed severe acidemia were analyzed.ResultsAmong 2, 550 critically ill patients, 200 (8%) presented with severe acidemia, and 155 (6% of the total admissions) met the inclusion criteria. Almost all patients needed mechanical ventilation and vasopressors during their ICU stay, and 20% of them required renal replacement therapy within the first 24 hours of their ICU stay. Severe metabolic or mixed acidemia was associated with a mortality rate of 57% in the ICU. Delay of acidemia recovery as opposed to initial pH value was associated with increased mortality in the ICU. The type of acidemia did not influence the decision to administer sodium bicarbonate.ConclusionsThe incidence of severe metabolic or mixed acidemia in critically ill patients was 6% in the present study, and it was associated with a 57% mortality rate in the ICU. In contradistinction with the initial acid-base parameters, the rapidity of acidemia recovery was an independent risk factor for mortality. Sodium bicarbonate prescription was very heterogeneous between ICUs. Further studies assessing specific treatments may be of interest in this population.

Lactic Acidosis: Current Treatments and Future Directions

“…3 Nonetheless, hyperlactatemia implies the presence of lactic acidosis, in which there is net addition of lactate and protons to the body fluids. 3,7 Limited data suggest that at a given blood lactate level, acidemia is associated with worse clinical outcomes 8,9 ; however, further work is required on this important issue. Sustained hyperlactatemia in sepsis or low-flow states carries mortality $ 60%.…”

Metabolic Acidosis: Diagnostics and Treatment

“…Метаболический ацидоз -распространенное кис-лотно-щелочное расстройство, связанное c развитием жизнеугрожающих состояний [1]: уровень рН артери-альной крови снижается < 7,35, концентрация бикарбо-ната (НСО 3 -) -< 18 ммоль/л, но парциальное давление углекислого газа в артериальной крови (PaCO 2 ) при этом не повышается [2]. Причинами, обусловливающими подобное патофизиологическое состояние, могут быть гиперпродукция кислот, пониженная экскреция кислот и/или повышенная экскреция оснований [2].…”

Place des solutions de bicarbonate de sodium en réanimation

“…Dans une étude multicentrique, nous avons rapporté, qu'en fonction des centres, de 5 à 50 % des patients recevaient du bicarbonate de sodium dans le cadre d'une acidémie métabolique sévère (pH < 7,20) ; le mécanisme de l'acidémie n'influançant pas la déci-sion de prescription [7]. Des résultats comparables ont été retrouvés dans une enquête multicentrique auprès de 250 responsables nord-américains de programmes universitaires de néphrologie et de réanimation adulte [8] ou pédiatrique [9].…”

“…Le design de cette étude comprendra deux bras thérapeutiques (absence d'alcalinisation vs alcalinisation avec cible de pH à 7,30) et aura comme critère de jugement principal un critère composite (mortalité à j90 et/ou amélioration du score de défaillance d'organe SOFA à j7). L'hypothèse de travail est un effet bénéfique du traitement symptomatique par bicarbonate de sodium chez des ces patients dont la mortalité est estimé à près de 60 % dans une étude préliminaire multicentrique [7].…”