Critical Illness: BIRCAR-ICU (2018)

Question 1

BICAR-ICU Clinical Q

Answer 1

In acutely ill patients in the intensive care unit with severe metabolic acidosis, does treatment with sodium bicarbonate reduce all-cause mortality at day 28 or the presence of ≥1 organ failure at day 7?

Question 2

BICAR-ICU Bottom Line

Answer 2

In this study, ICU patients with severe metabolic acidosis treated with sodium bicarbonate did not have improvement in all-cause mortality at day 28 or the presence of ≥1 organ failure at day 7. However, patients with AKI (a pre-specified subgroup) did experience a reduction in this endpoint

Question 3

BICAR-ICU Primary Outcome

Answer 3

All-cause mortality at day 28 or the presence of ≥1 organ failure at day 7

Question 4

BICAR-ICU inclusion criteria

Answer 4

• Adult patients age ≥18 years
• 48 hours within admission to ICU with severe acidemia, defined as pH ≤7.20, PaCO2 ≤ 45 mm Hg, and sodium bicarbonate concentration ≤ 20 mmol/L
• Sequential Organ Failure Assessment (SOFA) score of 4 or more, or arterial lactate concentration of 2 mmol/L or more

Question 5

BICAR-ICU Intervations

Answer 5

Bicarbonate 4.2% sodium bicarbonate intravenously with aim of goal arterial pH of ≥7.30 during 28-day ICU admission or ICU discharge; recommended infusion at 125-250 mL in 30 min, with max 1L in 24 hours after inclusion

Question 6

BICAR-ICU criticisms

Answer 6

• Unable to blind treating physicians and nursing since arterial blood gases are affected by bicarbonate administration
• 24% of control group received sodium bicarbonate, potentially underestimating treatment effect