The Janus faces of bicarbonate therapy in the ICU
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Metabolic acidosis is characterized by a primary reduction in plasma bicarbonate concentration below 20 mmol/L in the Henderson–Hasselbalch method and with either an imbalance between strong plasma cations concentration compared to the strong anions concentration (decreasing thus the strong ion difference) and/or an excess in non-volatile weak acids in the Stewart–Fencl method [1, 2]. Acidemia is the term used if the plasma pH is equal to or below 7.38, acidemia being described as severe when the pH is equal to or below 7.20 [3, 4]. Metabolic acidemia can be associated with organ failure, in particular respiratory failure (increased ventilatory demand) and cardiovascular failure (arterial vasodilation, decreases in cardiac inotropism and cardiac output, ventricular arrhythmia) [1, 5, 6]. Metabolic acidemia is observed in 14–42% of the critically ill patients  and, when acidemia is severe (pH < 7.20) and persists, is associated with 50–60% mortality in the Intensive...
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Conflicts of interest
Pr. Jaber reports receiving consulting fees from Drager, Fisher & Paykel and Fresenius.
- 7.Jung B, Rimmele T, Le Goff C et al (2011) Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. A prospective, multiple-center study. Crit Care 15:R238. https://doi.org/10.1186/cc10487 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Jaber S, Paugam C, Futier E et al (2018) Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet 392:31–40. https://doi.org/10.1016/S0140-6736(18)31080-8 CrossRefPubMedGoogle Scholar
- 16.Gaudry S, Verney C, Hajage D et al (2018) Hypothesis: early renal replacement therapy increases mortality in critically ill patients with acute on chronic renal failure. A post hoc analysis of the AKIKI trial. Intensive Care Med 44:1360–1361. https://doi.org/10.1007/s00134-018-5210-0 CrossRefPubMedGoogle Scholar