Boris Jung, Thomas Rimmele, Charlotte Le Goff, Gerald Chanques, Philippe Corne, Olivier Jonquet, Laurent Muller, Jean-Yves Lefrant, Christophe Guervilly, Laurent Papazian, Bernard Allaouchiche, Samir Jaber, The AzuRea group Critical Care 2011, 15:R238 (13 October 2011)
Introduction: A study to describe the incidence and the outcome of severe metabolic or mixed acidemia in critically ill patients and to describe the use of sodium bicarbonate therapy to treat it.
Methods: This is a prospective, observational, multiple center study. Consecutive patients who presented severe acidemia, defined herein as a plasma pH below 7.20 were screened. Incidence, sodium bicarbonate prescription and outcome facing either metabolic or mixed severe acidemia were further analyzed.
Results: Among 2550 critically ill patients, 200 (8%) presented 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 24h of the ICU stay. Severe metabolic or mixed acidemia was associated with a mortality rate in the ICU of 57%. 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.
Conclusions: Incidence of severe metabolic or mixed acidemia in the critically ill was 6% in the present study and it was associated with a 57% mortality rate in the intensive care unit. In contradistinction with the initial acid-base parameters, the rapidity of acidemia recovery was an independent risk factor of mortality. Sodium bicarbonate prescription was very heterogeneous between ICUs. Further studies assessing specific treatments may be of interest in this population.
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