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Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department
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Increased serum bicarbonate in critically ill patients: a retrospective analysis
Alexandre Braga Libório1, Danilo Teixeira Noritomi, Tacyano Tavares Leite
1Department of Clinical Medicine, Universidade Federal do Ceará, Av. Abolição, 4043 Ap 1203, Ed. Jangada, Fortaleza, CE, CEP 60165-082, Brazil, alexandreliborio@yahoo.com.br.
Intensive Care Medicine
|January 21, 2015
Summary
High serum bicarbonate levels are common in critically ill patients and are linked to worse outcomes, including increased mortality. This finding holds true regardless of the underlying causes of metabolic alkalosis.
Area of Science:
- Critical Care Medicine
- Nephrology
- Internal Medicine
Background:
- Metabolic alkalosis is a frequent clinical observation.
- Limited data exists on its prevalence and impact in intensive care settings.
Purpose of the Study:
- To investigate the prevalence of metabolic alkalosis in critically ill patients.
- To identify factors associated with metabolic alkalosis.
- To determine the outcomes associated with metabolic alkalosis.
Main Methods:
- Retrospective analysis of the Multiparameter Intelligent Monitoring in Intensive Care II database.
- Inclusion of 18,982 adult patients meeting specific criteria.
- Evaluation of serum bicarbonate levels and associated clinical data.
Main Results:
- A U-shaped association between serum bicarbonate and mortality was observed.
- 29.3% of patients had serum bicarbonate >30 mEq/l, often due to diuretic use, hypernatremia, hypokalemia, or high gastric output.
- Elevated serum bicarbonate correlated with longer ICU stays, increased mechanical ventilation days, and higher hospital mortality.
- Each 5 mEq/l increase above 30 mEq/l was associated with a 1.21 odds ratio for mortality, independent of etiology.
Conclusions:
- Increased serum bicarbonate is prevalent in critically ill patients.
- Multiple factors contribute to elevated bicarbonate levels.
- The presence and duration of high serum bicarbonate negatively impact patient outcomes in the ICU.
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