Sodium bicarbonate in 5% dextrose: can clinicians tell the difference?

Area of Science:

• Critical Care Medicine
• Clinical Pharmacology
• Patient Safety

Background:

• The efficacy of intravenous sodium bicarbonate for metabolic acidosis in intensive care unit (ICU) patients lacks robust evidence due to insufficient double-blind randomized controlled trials.
• Blinding is crucial for trial integrity, yet the feasibility of blinding sodium bicarbonate administration has not been adequately assessed.

Purpose of the Study:

• To determine if intensive care unit clinicians can differentiate between sodium bicarbonate and dextrose solutions when prepared in a manner suitable for blinded administration.
• To assess the feasibility of blinding sodium bicarbonate therapy in clinical research settings.

Main Methods:

• A blinded study involved 60 ICU clinicians (nurses, physicians, pharmacist) who inspected 250 mL intravenous bags.
• Bags contained either 8.4% sodium bicarbonate diluted in dextrose 5% in water (D5W) or a control solution (D5W with a portion removed and replaced).
• Participants attempted to identify the contents of the prepared intravenous bags.

Main Results:

• Only 60% of clinicians correctly identified the bag contents, indicating a low level of accuracy.
• The agreement between the actual bag content and the clinicians' identification was poor (Cohen κ = 0.20), suggesting identification was close to chance.
• There was no significant difference in correct identification rates between clinicians who used a clue versus those who did not.

Conclusions:

• Intensive care unit clinicians were unable to reliably distinguish between sodium bicarbonate and D5W solutions when prepared using the tested dilution method.
• These findings strongly support the feasibility of successfully blinding sodium bicarbonate administration in clinical trials.
• The successful blinding of sodium bicarbonate therapy can enhance the validity of future research investigating its use in critical care.