Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial

Acute acidaemia is frequently observed during critical illness, with a reported incidence varying from 14% to 42%. Persistent acidaemia has been associated with poor prognosis, with a mortality rate as high as 57% when the pH stays below 7⋅20.5 Along with case specific treatment, improvement of tissue perfusion and supportive measures such as mechanical ventilation and renal-replacement therapy are the cornerstones of severe metabolic acidaemia management in critically ill patients. Because an acidotic cellular environment can cause cellular dysfunction, intravenous sodium bicarbonate administration to increase the pH might also be beneficial. In a survey done in North America, more than two-thirds of the programme directors in nephrology or intensive care units (ICUs) declared that they used sodium bicarbonate for the treatment of acidaemia with hyperlactataemia.

Lancet. 2018 Jul 7;392(10141):31-40. doi: 10.1016/S0140-6736(18)31080-8