An IV Sodium Bicarbonate Shortage in the Critically Ill: An Interrupted Time-Series Analysis

Area of Science:

• Critical Care Medicine
• Nephrology
• Pharmacology

Background:

• The 2017 worldwide shortage of intravenous (IV) sodium bicarbonate presented a challenge for managing critically ill patients with acidemia.
• Acidemia, a condition of excessive acidity in the blood, often requires treatment with IV sodium bicarbonate.

Purpose of the Study:

• To investigate the impact of the 2017 IV sodium bicarbonate shortage on treatment patterns and clinical outcomes in critically ill adults with acidemia.
• To assess whether emergency conservation measures during the shortage affected patient outcomes.

Main Methods:

• An interrupted time-series analysis was conducted using data from 17 adult intensive care units (ICUs) in Alberta, Canada.
• The study included 18,865 adult ICU admissions between June 1, 2015, and December 31, 2019, focusing on patients with a blood pH < 7.3.
• Segmented regression analysis examined trends in IV sodium bicarbonate use and patient outcomes before, during, and after the shortage period (June 8 to October 4, 2017).

Main Results:

• Immediately following the shortage, the proportion of patients receiving IV sodium bicarbonate decreased significantly (from 29.3% to 21.5%).
• During the shortage, patients treated with bicarbonate were more likely to have severe acidemia (pH ≤ 7.20).
• Among patients with pH ≤ 7.20 or advanced renal insufficiency who did not receive bicarbonate, there was a trend towards increased use of vasopressors and continuous renal replacement therapy, but no significant changes in ICU length of stay or mortality were observed.

Conclusions:

• Emergency conservation measures during the 2017 IV sodium bicarbonate shortage successfully reduced its use in critically ill acidemic patients.
• The reduction in IV sodium bicarbonate administration was not associated with adverse effects on survival or ICU length of stay.
• Future research should explore the optimal use of sodium bicarbonate in specific patient subgroups, particularly those with severe acidemia and/or significant renal impairment.