Research
Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. a prospective, multiple-center study
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* Corresponding author: Samir Jaber s-jaber@chu-montpellier.fr
1 Intensive Care Unit, Department of Anaesthesia and Critical Care, Saint Eloi Teaching Hospital, Université Montpellier 1, 80 avenue Augustin Fliche, F-34295 Montpellier, Cedex 5, France
2 Department of Anesthesiology and Critical Care Medicine, Edouard-Herriot Teaching Hospital, hospices civils de Lyon, pavillon G, place d'Arsonval, F-69437 Lyon Cedex 03, France
3 Medical Intensive Care Unit, Gui-de-Chauliac Teaching Hospital, Université Montpellier 1, 80 avenue Augustin Fliche, F-34295 Montpellier Cedex 5, France
4 Anesthesiology, Pain Medicine, Emergency and Critical Care Medicine Division, Caremeau Teaching Hospital, Centre Hospitalier Universitaire Nîmes, Place du Professeur Robert Debré, F-30029 Nîmes Cedex 9, France
5 Medical Intensive Care Unit, Assistance Publique Hôpitaux de Marseille, URMITE CNRS-UMR 6236, Université de la Méditerranée Aix-Marseille II, Chemin des Bourrely, 13915 Marseille cedex 20, France
Critical Care 2011, 15:R238 doi:10.1186/cc10487
Published: 13 October 2011Abstract
Introduction
In 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.
Methods
We 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.
Results
Among 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.
Conclusions
The 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.