The Efficacy and Safety of Sodium Bicarbonate Ringer’s Solution in Critically Ill Patients: A Retrospective Cohort Study

Abstract

Background: Sodium bicarbonate Ringer’s solution has been widely used in clinical practice in recent years. There are few clinical studies on the efficacy and safety of this fluid among critically ill patients until now.Method: This retrospective cohort study included critically ill adult patients in the intensive care unit (ICU) of Tongji Hospital from 1 January 2019 to 31 December 2020. By reviewing exclusively the use of either sodium bicarbonate Ringer’s solution or saline for resuscitation or maintenance, the patients were included into two groups, respectively. The primary outcome was the major adverse kidney event within 30 days (MAKE30), including death, new receipt of renal replacement therapy, or persistent renal dysfunction. Safety outcomes were focused on arterial blood gas and plasma biochemical alterations, which might potentially be induced by the administration of bicarbonate Ringer’s solution.Result: A total of 662 patients were included in the cohort. Compared to the saline group, the bicarbonate Ringer’s group had a significantly lower rate of the new receipt of renal replacement therapy [adjusted odds ratio (OR) = 0.591, 95% confidence interval (CI), 0.406 to 0.861; p = 0.006]. There was no significant difference between the two groups in 30-day mortality, final creatinine level ≥200% of baseline, and major adverse kidney event within 30 days. In subgroup analysis, the incidence of MAKE30 was higher in the bicarbonate Ringer’s group than that of the saline group among patients with cardiovascular disease. The patients in the bicarbonate Ringer’s group had a longer length of intensive care unit stay than patients in the saline group, but their new renal replacement therapy days were shorter. No major alterations were found in arterial blood gas and plasma biochemical during the follow-up period.Conclusion: Compared to saline, sodium bicarbonate Ringer’s solution exhibited a potential renal function protective effect while causing no major alterations in arterial blood gas and plasma biochemistry. However, the application in patients with cardiovascular disease diagnosis at ICU admission should be cautious.

The efficacy of sodium bicarbonated Ringer’s solution versus lactated Ringer's solution for goal-directed fluid therapy in elderly patients undergoing gastrointestinal surgery: a prospective randomized controlled trial

“…We also found an improvement in the minor complications in the BRS group like reducing the incidence of wound bleeding and impaired liver function. It indicates that BRS can alleviate liver function metabolic burden and inhibit the aggravation of coagulation dysfunction to a certain extent during uid therapy [29]. Study by Su et al showed that LRS can cause granulocyte respiration bursts, aggravate systemic in ammations and then increase the capillary permeability and aggravate the tissue edema [30].…”

Effect of Sodium Bicarbonate Ringer’s Solution on Intraoperative Blood Gas Analysis and Postoperative Recovery Time in Liver Transplantation: A Single-Center Retrospective Study

“…Therefore, for liver transplant patients, intraoperative input of LRS will increase liver and kidney load and is not an ideal crystal solution. BRS is a physiological alkaline buffer with HCO 3 , which is a direct alkaline effect by binding with H + to quickly correct the acidosis and maintain acid-base balance [ 21 , 22 ]. BRS is a new type of balanced crystal buffered by bicarbonate rather than organic anions, in which case it may perform better at preserving the acid-base state [ 23 ].…”

Utilization of interpretable machine learning model to forecast the risk of major adverse kidney events in elderly patients in critical care

“…[creatinine = 0.74 − 0.2 (if female) + 0.08 (if African American) + 0.003 × age (in years)]. If a patient had documented CKD, it was defined as the lowest creatinine value during hospitalization [ 6 , 9 , 24 , 25 ]. Baseline glomerular filtration rates were calculated using the Modification of Diet in takes diseases equation estimation [ 26 ].…”