title: Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. A prospective, multiple-center study.
abstract: BACKGROUND
  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.
authors: 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.
authors: Boris
authors: B
authors: Jung
authors: Thomas
authors: T
authors: Rimmele
authors: Charlotte
authors: C
authors: Le Goff
authors: Gérald
authors: G
authors: Chanques
authors: Philippe
authors: P
authors: Corne
authors: Olivier
authors: O
authors: Jonquet
authors: Laurent
authors: L
authors: Muller
authors: Jean-Yves
authors: JY
authors: Lefrant
authors: Christophe
authors: C
authors: Guervilly
authors: Laurent
authors: L
authors: Papazian
authors: Bernard
authors: B
authors: Allaouchiche
authors: Samir
authors: S
authors: Jaber
mesh_terms: D000138:Acidosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D000368:Aged; D002021:Buffers; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012720:Severity of Illness Index; D017693:Sodium Bicarbonate / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D002021:Buffers; D054328:Proton Pump Inhibitors; D017693:Sodium Bicarbonate