Sodium Bicarbonate in Different Critically Ill Conditions: From Physiology to Clinical Practice

Coppola, Silvia; Caccioppola, Alessio; Froio, Sara; Chiumello, Davide

doi:10.1097/aln.0000000000003733

Cited by 15 publications

(10 citation statements)

References 78 publications

(142 reference statements)

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“…Eighty patients with lung cancer who underwent PICC puncture were selected as the subjects of the retrospective study and were divided into 40 cases each in the comparison group and the observation group according to the random remainder grouping method, and both groups were placed with single-lumen 4F or 5F catheters from BD, USA, under aseptic conditions: chills, except fever due to infection at other sites, positive culture of pathogenic bacteria in catheter blood, and significant decrease or return to normal temperature after perturbation; catheter blood and peripheral blood both cultured the same kind of bacteria or fungi. Patients with lung cancer chemotherapy all meet the indications for PICC tubes [ 4 ]: (i) lack of peripheral venous access, (ii) infusion of irritating drugs such as chemotherapy, and (iii) need for prolonged intravenous therapy. The drug flow rate is not affected by the patient's body position; the exterminate of chemotherapeutic drugs is effectively avoided; it can be retained for a long time, up to 1 year.…”

Section: Methodsmentioning

confidence: 99%

Effects of Peripherally Inserted Central Catheter (PICC) Catheterization Nursing on Bloodstream Infection in Peripheral Central Venous Catheters in Lung Cancer: A Single-Center, Retrospective Study

Qiu

2022

Computational and Mathematical Methods in Medicine

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Background Peripherally inserted central catheter (PICC), as one of the important intravenous routes for the rescue and treatment of critically ill patients, has been widely used in the fluid resuscitation of critically ill patients in intensive care. In particular, PICC can be widely used in the treatment of cancer patients. With the wide application of peripheral central venous catheterization, the clinical findings of bloodstream infection complications caused by PICC have gradually attracted the attention of doctors and patients. Aims To investigate the effect of specialized placement and PICC placement care on patients with lung cancer who underwent PICC puncture. Patients were selected and divided into a comparison group and an observation group of 40 patients each according to the randomized residual grouping method. In the comparison group, routine PICC placement and catheter maintenance were performed, while the observation group was provided with specialized placement and PICC placement care. The differences in immune and tumor marker levels and nursing compliance between the two groups were observed and compared before and after nursing care. Results There was no significant difference in the comparison of tumor marker levels between the two groups of patients before care, while the levels of CYFRA21-1, CA125, and VGEF in the observation group were significantly lower than those in the comparison group after care, and this difference was statistically significant ( P < 0.05). There was no statistically significant difference in the comparison of immune levels between the two groups before care ( P > 0.05), while the comparison of CD4+, CD3+, and CD4+/CD8+ after care was significantly different and higher in the observation group than in the comparison group, and the comparison was statistically significant ( P < 0.05). The compliance rate of 93.8% in the observation group was significantly higher than that of 77.9% in the comparison group, and this difference was statistically significant for comparison ( P < 0.05). Conclusion PICC placement care is more effective in patients with lung cancer and performing PICC puncture, significantly improves patients' immune and tumor marker levels, improves patients' negative emotions, reduces disease uncertainty, and improves nursing compliance.

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Section: Methodsmentioning

confidence: 99%

Effects of Peripherally Inserted Central Catheter (PICC) Catheterization Nursing on Bloodstream Infection in Peripheral Central Venous Catheters in Lung Cancer: A Single-Center, Retrospective Study

Qiu

2022

Computational and Mathematical Methods in Medicine

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“…Using sodium bicarbonate as a buffer in this setting is potentially problematic due to its potential to generate CO 2 as part of the acid buffering process in an already hypercarbic patient with limited ability to increase minute ventilation. 7 Furthermore, although permissive hypercapnia in ARDS is usually well-tolerated, hypercarbic acidosis may reduce myocardial contractility and SVR, and increase PVR with right ventricular dysfunction. 33 Hypercarbic acidosis may even produce more myocardial depression than metabolic acidosis due to greater cellular permeability of CO 2 with a lower resultant intracellular pH and a decreased responsiveness of muscle myofilaments to calcium.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to hemodialysis, intravenous sodium bicarbonate has been used for this purpose, but without a clear mortality benefit and with concern for potential harm related to CO 2 generation, subsequent intracellular acidosis, and hypernatremia. 7 As an alternative to sodium bicarbonate, THAM increases buffering ability for acid loads without causing hypernatremia or generating CO 2 , and in small investigations reduces the partial pressure of carbon dioxide in the blood (Pa co 2 ). 1…”

mentioning

confidence: 99%

Tris-Hydroxymethyl Aminomethane in Critically Ill Adults: A Systematic Review

Radosevich¹,

Wieruszewski

Wittwer³

2023

Anesthesia &Amp; Analgesia

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Tris-hydroxymethyl aminomethane (THAM) is an amino alcohol used clinically to buffer acid loads and raise pH in acidotic conditions. Unlike sodium bicarbonate, which increases plasma sodium levels with use and produces carbon dioxide (CO2) as part of the buffering process, THAM does neither. Although not widely used in modern critical care and unavailable for clinical use in 2016, THAM has been available in the United States since 2020. Clinical experience and existing literature suggest that THAM may have clinical utility in acid-base management in conditions such as liver transplantation where rising sodium levels during perioperative care may be dangerous, and in managing acid-base derangements during care of patients with acute respiratory distress syndrome (ARDS). To clarify the evidence base supporting the clinical use of THAM, we conducted a systematic review to assess the efficacy and safety of THAM as a buffering agent in critically ill adults using Ovid EBM Reviews, Ovid Embase, Ovid Medline, Scopus, and Web of Science Core Collection. Randomized-, crossover-, retrospective cohort-, parallel-designed clinical trials, case series, and case reports of adult patients who received THAM in the operative or critical care setting were included. Conference abstracts of qualifying study designs were also included. Two independent reviewers extracted the data regarding the study details, demographics, treatment, and outcomes data. A third reviewer adjudicated discrepancies. A total of 21 studies including 3 randomized controlled trials, 5 observational studies, 4 case series, and 9 case reports met inclusion criteria. Eight studies (38%) were abstracts published in conference proceedings. In total, 417 critically ill patients received THAM to treat acidosis in critically ill surgical and nonsurgical patients, during liver transplantation, and in ARDS. In general, THAM corrected acidosis with an efficacy equivalent to sodium bicarbonate and did so with less hypercarbia and hypernatremia. Adverse effects of THAM included hyperkalemia, hypoglycemia, ventilator depression, and tissue damage with extravasation. We conclude that THAM may have potential advantages in some critical care settings, but that clinical evidence is limited, and high-quality evaluations are necessary.

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“…Due to the saponification of calcium (the combination of calcium and free fatty acids released from the fat autodigestion) in acute pancreatitis, hypocalcemia has a high incidence in AP and has been correlated with reduced myocardial contractility, manifested in QT prolongation, decreased vascular tone and hypotension 27,28 . When patients receive SB infusion, the sudden elevation of pH could accelerate the combination between calcium and albumin, leading to a sudden drop in Ionized Calcium, which could further aggravate hypocalcemia, impair myocardial contractility and result in lactate elevation 29 . To confirm this circle, we performed subgroup analysis on AP patients with hypocalcemia (serum calcium, < 8.5 mmol/L) and hypoalbuminemia (serum albumin, < 30 g/L) and indicated that SB administration did harm those patients.…”

Section: Discussionmentioning

confidence: 99%

Adverse Impact of Sodium Bicarbonate Administration on Multiple Outcomes in Acute Pancreatitis Patients With Hyperlactatemia

Yan,

Zhang,

et al. 2023

Pancreas

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Objective Hyperlactatemia is likely to occur among patients with acute pancreatitis (AP). Sodium bicarbonate (SB) therapy could be applied to correct potential detrimental acidic disturbances, but the exact impact of SB treatment is unknown. This study aims to investigate the impact of SB on AP patients complicated with hyperlactatemia. Methods The study was conducted based on the database named Medical Information Mart for Intensive Care-IV (MIMIC-IV). Propensity matching (PSM) and inverse probability weighting (IPTW) were used to balance the baseline differences. Multivariate regression and marginal structural Cox models were performed to investigate the association between SB and multiple outcomes. Results Three hundred fifty-three AP patients with hyperlactatemia (initial serum lactate, >2.0 mmol/L) were extracted from the MIMIC-IV database. We found that SB treatment was significantly associated with worse multi-outcomes of AP patients with hyperlactatemia (in-hospital mortality: hazard ratio, 2.46; 95% confidence interval, 1.38–4.39; P < 0.01). Further analysis through marginal structural Cox models showed that SB had adverse impact on in-hospital prognosis of patients with severe lactic acidosis (pH < 7.15,lactate > 2.0 mmol/L). Conclusion Sodium bicarbonate might not be an appropriate treatment for AP patients with hyperlactatemia (lactate > 2.0 mmol/L) or with severe lactic acidosis (pH < 7.15, lactate > 2.0 mmol/L).

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Sodium Bicarbonate in Different Critically Ill Conditions: From Physiology to Clinical Practice

Abstract: Intravenous sodium bicarbonate is commonly used in several critically ill conditions for the management of acute acidemia independently of the etiology, and for the prevention of acute kidney injury, although this is still controversial from a physiologic point of view.

Cited by 15 publications

References 78 publications

Effects of Peripherally Inserted Central Catheter (PICC) Catheterization Nursing on Bloodstream Infection in Peripheral Central Venous Catheters in Lung Cancer: A Single-Center, Retrospective Study

Effects of Peripherally Inserted Central Catheter (PICC) Catheterization Nursing on Bloodstream Infection in Peripheral Central Venous Catheters in Lung Cancer: A Single-Center, Retrospective Study

Tris-Hydroxymethyl Aminomethane in Critically Ill Adults: A Systematic Review

Adverse Impact of Sodium Bicarbonate Administration on Multiple Outcomes in Acute Pancreatitis Patients With Hyperlactatemia

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