Intravenous sodium bicarbonate in lactic acidosis: A systematic review and meta-analysis of cohort studies and randomized trials
CCCF ePoster library. Laiya Carayannopoulos K. 11/13/19; 285183; EP100
Kallirroi Laiya Carayannopoulos
Kallirroi Laiya Carayannopoulos
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Abstract
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Introduction: Severe acidemia can affect myocardial function and impair the vascular response to catecholamines. While the administration of sodium bicarbonate to correct metabolic acidosis theoretically improves these parameters, little data is available to support its use in critically ill patients. We undertook a systematic review to assess the efficacy and safety of intravenous sodium bicarbonate in patients with lactic acidosis.
Methods: We searched MEDLINE, EMBASE and the Cochrane Library from inception to October 2018 with no language restrictions for randomized controlled trials and observational studies comparing intravenous sodium bicarbonate versus placebo or no sodium bicarbonate in critically ill adult patients with lactic acidosis. Outcomes included mortality (during ICU stay or at 28 days), need for or duration of vasopressor use, need for or duration of renal replacement therapy, serum pH and adverse events. Screening, risk of bias assessment and data extraction were all completed independently and in duplicate. We used the GRADE approach to assess quality of evidence. This study was prospectively registered, PROSPERO: CRD42018103595.
Results: We identified 6 studies (5 observational, 1 RCT) that met our eligibility criteria, representing a total of 4008 patients with lactic acidosis. The use of intravenous sodium bicarbonate did not reduce mortality in both observational studies (odd ratio [OR] 1.24, 95% CI 0.84 to 1.85, very low certainty) and an RCT (OR 0.70, 95% CI 0.47 to 1.04, moderate certainty), duration of vasopressor use (observational MD 1.4 days, 95% CI -3.53 to 0.73, very low certainty, RCT MD 0, 95% CI -0.37 to 0.37, low certainty). The odds of hypokalemia was higher with administering sodium bicarbonate (observational RR 2.67, 95% CI 1.18 to 6.03, moderate certainty, RCT MD 1.14, 95% CI 0.86 to 1.51, low certainty). Only one study reported need for renal replacement therapy (RRT) and found that bicarbonate therapy reduces the need for RRT (OR 0.51, 95% CI 0.34 to 0.77, moderate certainty.
Conclusion: Low-quality evidence demonstrates that the use of intravenous sodium bicarbonate does not reduce mortality in patients with lactic acidosis. The use of sodium bicarbonate may, however, reduce the need for RRT in patients with lactic acidosis and acute kidney injury.  
 

Introduction: Severe acidemia can affect myocardial function and impair the vascular response to catecholamines. While the administration of sodium bicarbonate to correct metabolic acidosis theoretically improves these parameters, little data is available to support its use in critically ill patients. We undertook a systematic review to assess the efficacy and safety of intravenous sodium bicarbonate in patients with lactic acidosis.
Methods: We searched MEDLINE, EMBASE and the Cochrane Library from inception to October 2018 with no language restrictions for randomized controlled trials and observational studies comparing intravenous sodium bicarbonate versus placebo or no sodium bicarbonate in critically ill adult patients with lactic acidosis. Outcomes included mortality (during ICU stay or at 28 days), need for or duration of vasopressor use, need for or duration of renal replacement therapy, serum pH and adverse events. Screening, risk of bias assessment and data extraction were all completed independently and in duplicate. We used the GRADE approach to assess quality of evidence. This study was prospectively registered, PROSPERO: CRD42018103595.
Results: We identified 6 studies (5 observational, 1 RCT) that met our eligibility criteria, representing a total of 4008 patients with lactic acidosis. The use of intravenous sodium bicarbonate did not reduce mortality in both observational studies (odd ratio [OR] 1.24, 95% CI 0.84 to 1.85, very low certainty) and an RCT (OR 0.70, 95% CI 0.47 to 1.04, moderate certainty), duration of vasopressor use (observational MD 1.4 days, 95% CI -3.53 to 0.73, very low certainty, RCT MD 0, 95% CI -0.37 to 0.37, low certainty). The odds of hypokalemia was higher with administering sodium bicarbonate (observational RR 2.67, 95% CI 1.18 to 6.03, moderate certainty, RCT MD 1.14, 95% CI 0.86 to 1.51, low certainty). Only one study reported need for renal replacement therapy (RRT) and found that bicarbonate therapy reduces the need for RRT (OR 0.51, 95% CI 0.34 to 0.77, moderate certainty.
Conclusion: Low-quality evidence demonstrates that the use of intravenous sodium bicarbonate does not reduce mortality in patients with lactic acidosis. The use of sodium bicarbonate may, however, reduce the need for RRT in patients with lactic acidosis and acute kidney injury.  
 

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