Related Experiment Video
Updated: May 23, 2026
Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device
Published on: September 24, 2020
Sodium Bicarbonate for Acute Metabolic Acidosis in Critically Ill Adults: A Meta-Analysis of Randomized Clinical
Jia-Jin Chen1,2, Tao-Han Lee3, Chih-Hsiang Chang1,2
1Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan city, Taiwan.
Objectives:
Acute metabolic acidosis is frequent in critical illness and may be managed with volume replacement therapy, sodium bicarbonate, and renal replacement therapy (RRT). BICARICU-1 and BICARICU-2 trials provided new evidence on bicarbonate therapy. We aimed to systematically evaluate the effects of sodium bicarbonate in critically ill patients.
Data Sources:
We systematically searched PubMed, Embase, Medline, and the Cochrane Library for randomized controlled trials (RCTs) evaluating sodium bicarbonate vs. placebo in critically ill adults with acute metabolic acidosis.
Study Selection:
Only RCTs were selected.
Data Extraction:
Primary outcome was RRT; secondary outcomes were mortality, ICU length of stay, ventilator-free days, and vasopressor-free days.
Data Synthesis:
We performed Hartung-Knapp random-effects meta-analyses and trial sequential analysis (TSA) for primary outcomes. Bayesian random-effects meta-analyses with noninformative and weakly informative priors were used for sensitivity analysis. Four trials enrolling 1,111 patients were included. Sodium bicarbonate showed a nonsignificant trend toward lower mortality (risk ratio [RR], 0.84; 95% CI, 0.55-1.30); TSA indicated that the cumulative sample size remained far below the required information size, and the mortality effect is inconclusive. Sodium bicarbonate significantly reduced RRT use (RR, 0.69; 95% CI, 0.61-0.78), and TSA supported firm evidence of benefit. Bayesian analyses estimated posterior probabilities of any mortality reduction (RR < 1) and reduced RRT use of 90.4% and 94.6%, respectively. Secondary outcomes remained imprecise, with a trend of toward more vasopressor-free days.
Conclusions:
In critically ill adults with acute metabolic acidosis, sodium bicarbonate significantly reduces RRT requirement, with Bayesian analyses suggesting a possibility of mortality benefit, although current evidence remains inconclusive. Larger RCTs or high-quality real-world studies are needed to confirm efficacy of sodium bicarbonate for mortality.
More Related Videos
Related Concept Videos
01:24Diagnosing Acidosis and Alkalosis
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and HCO3− values are examined to...
02:58Bronsted-Lowry Acids and Bases
01:22Bicarbonate-Carbonic Acid Buffer
01:29Disorders of Acid-Base Balance
Respiratory Acidosis and Alkalosis
Respiratory acidosis occurs due to an increase in the partial pressure of carbon dioxide PCO2 in the blood. It often arises from shallow breathing or impaired gas exchange caused by...
01:29Roles of Electrolytes: Chloride and Bicarbonate
Conditions such as hypochloremia can arise from insufficient chloride reabsorption by the kidneys, often compounded by extended bouts of diarrhea, vomiting, or...
01:28Compensation Mechanisms
Respiratory Compensation
This mechanism addresses metabolic-induced pH imbalances by adjusting breathing rates. Respiratory compensation begins within minutes of detecting a pH...