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Buffer therapy in severe metabolic or mixed acidosis

Introduction

The current literature does not support buffers in acidosis except when facing proven losses of bicarbonates [1]. However, human studies are lacking and data are supported by in vitro or animal studies that showed the side effects of bicarbonates. The aim of this study was firstly to describe the frequency of buffering therapy in ICU and secondly to compare the outcome between patients treated by buffers (buffer group) or not (nonbuffer group).

Methods

A prospective, multiple-center, observational study. All patients presenting a severe metabolic or mixed acidosis (pH <7.20) were screened. Acidoketosis was secondarily excluded. The mechanism of acidosis was defined by classical analyses [2]. At admission, Simplified Acute Physiology Score (SAPS) II and Sequential Organ Failure Assessment (SOFA) scores, pH, bicarbonatemia, lactatemia, dialysis, mechanical ventilation and vasopressor use were recorded. At ICU discharge, lengths of stay, mechanical ventilation and mortality were recorded. Data are presented as the medians and quartile ranges and compared with the Mann–Whitney and Fisher's exact tests.

Results

One hundred and forty-six were included for analysis. The main diagnosis at admission was septic shock (36%) and cardiac arrest (12%). Ninety were not treated with buffers and 56 were treated at day 0. Severity scores at admission (SOFA 10 (7 to 13) vs. 11 (9 to 13) and SAPS II 62 (50 to 81) vs. 71 (54 to 81)), frequency of vasopressors (86% vs. 93%), dialysis (17% vs. 26%) and mechanical ventilation (86% vs. 93%) in the nonbuffer and buffer groups, respectively, were not different. Bicarbonatemia was significantly lower in the buffer group than in the nonbuffer group (15 (10.3 to 18.0) vs. 13.4 (8.0 to 17.0); P < 0.05). No significant difference was observed between groups for length of stay in the (4 (2 to 5) vs. 3 (2 to 4) days) and mortality (58 vs. 59%) in the nonbuffer and buffer groups respectively.

Conclusion

In this multiple-center observational study, buffering practices was heterogeneous. Buffering therapy in severe acidosis (pH <7.20) does not seem to influence the ICU outcome. Further clinical studies should be performed to better define the impact of buffering therapy in selected patients in severe acidosis.

References

  1. 1.

    Gehlbach BK, Schmidt GA: Bench-to-bedside review: treating acid–base abnormalities in the intensive care unit – the role of buffers. Crit Care 2004, 8: 259-265. 10.1186/cc2865

  2. 2.

    Gunnerson KJ, Kellum JA: Acid–base and electrolyte analysis in critically ill patients: are we ready for the new millennium? [Review]. Curr Opin Crit Care 2003, 9: 468-473. 10.1097/00075198-200312000-00002

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Le Goff, C., Jung, B., Corne, P. et al. Buffer therapy in severe metabolic or mixed acidosis. Crit Care 13, P452 (2009). https://doi.org/10.1186/cc7616

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Keywords

  • Observational Study
  • Bicarbonate
  • Mechanical Ventilation
  • Septic Shock
  • Cardiac Arrest