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

IF 6 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Medicine Pub Date : 2025-08-04 DOI:10.1097/CCM.0000000000006813

Amanda Y Leong, Andrea Soo, Andrew Bond, Hannah Wunsch, Danny J Zuege, Sean M Bagshaw, Henry T Stelfox, Daniel J Niven

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引用次数: 0

Abstract

Objective: To examine effects of the 2017 worldwide shortage of IV sodium bicarbonate on outcomes of critically ill adults with acidemia.

Design: Interrupted time-series analysis.

Setting: Seventeen adult ICUs in Alberta, Canada.

Patients: Adults (≥ 18 yr) with blood pH value of less than 7.3, admitted to study ICUs between June 1, 2015, and 31 December 2019.

Interventions: The 2017 sodium bicarbonate shortage occurred between 8 June and October 4, 2017. Our health authority enacted emergency conservation measures during this time.

Measurements and main results: The main data source was eCritical Alberta, a population-based ICU Registry. The primary outcome was the proportion of patients treated with IV sodium bicarbonate. Outcomes were examined via segmented regression. Among 18,865 admissions, median age was 62 years (interquartile range [IQR] 50-71), median Acute Physiology and Chronic Health Evaluation (APACHE) II was 23 (IQR 18-30), and 39.6% were female. Immediately after start of the shortage, patients treated with bicarbonate decreased from 29.3% to 21.5% (absolute -7.8%; 95% CI, -12.8 to -2.8%). During the shortage bicarbonate recipients more likely had pH less than or equal to 7.20 (78.8% vs. 69.0%, p < 0.01). Subgroup analysis among those with pH less than or equal to 7.20 who did not receive bicarbonate during the shortage suggested increased proportion treated with vasopressors (9.9%; 95% CI, 2.4-17.4%) and continuous renal replacement therapy (8.6%; 95% CI, 0.6-16.6%). Similar trends were observed among those with renal sequential organ failure assessment greater than or equal to 3 who did not receive bicarbonate during the shortage. There was no change in ICU length of stay or mortality in overall population or subgroups.

Conclusions: Emergency conservation measures that accompanied a worldwide shortage of IV sodium bicarbonate were associated with a reduction in IV sodium bicarbonate use among critically ill patients with acidemia. This was not linked to changes in survival or length of stay outcomes. Future bicarbonate research should focus on subgroups such as those with severe acidemia and/or advanced renal insufficiency.

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危重病人静脉注射碳酸氢钠短缺：中断时间序列分析。

目的：探讨2017年全球静脉注射碳酸氢钠短缺对重症成人酸血症结局的影响。设计：中断时间序列分析。背景：加拿大阿尔伯塔省17个成人icu。患者：成人（≥18岁），血液pH值小于7.3，于2015年6月1日至2019年12月31日期间入住icu。干预措施：2017年碳酸氢钠短缺发生在2017年6月8日至10月4日之间。我们的卫生当局在此期间制定了紧急保护措施。测量和主要结果：主要数据来源是critical Alberta，一个基于人群的ICU登记处。主要终点是静脉注射碳酸氢钠治疗的患者比例。结果通过分段回归进行检验。18,865例入院患者中位年龄为62岁（四分位数区间[IQR] 50-71），急性生理和慢性健康评估（APACHE） II中位年龄为23岁（IQR 18-30），女性为39.6%。在短缺开始后，接受碳酸氢盐治疗的患者从29.3%下降到21.5%(绝对-7.8%；95% CI, -12.8至-2.8%)。在碳酸氢盐短缺期间，受者pH值小于或等于7.20的可能性更大（78.8%比69.0%,p < 0.01）。在pH小于或等于7.20的患者中，在短缺期间未接受碳酸氢盐治疗的亚组分析表明，接受血管加压药物治疗的比例增加(9.9%；95% CI, 2.4-17.4%)和持续肾脏替代治疗(8.6%；95% ci, 0.6-16.6%)。在肾序贯器官衰竭评估大于或等于3的患者中观察到类似的趋势，这些患者在短缺期间没有接受碳酸氢盐治疗。总体人群或亚组的ICU住院时间和死亡率均无变化。结论：紧急保护措施伴随着全球范围内静脉注射碳酸氢钠的短缺，与酸血症危重患者静脉注射碳酸氢钠的使用减少有关。这与生存或住院时间结果的变化无关。未来的碳酸氢盐研究应该集中在严重酸血症和/或晚期肾功能不全的亚群上。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.