Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 98: Update on Bicarb: BICAR-ICU
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Nov 14, 2018 Explore the insights of the BICAR-ICU trial, which examines sodium bicarbonate's role in treating metabolic acidosis. Discover the trial's findings on its effectiveness for lactic acidosis and its implications for kidney injury. Learn why reflexively increasing bicarbonate levels can be misguided, with emphasis on treating underlying causes. Understand the important differences between infusion and bolus methods, along with potential adverse effects of bicarbonate therapy. Dive into the nuances of acidosis treatment and share this knowledge with colleagues!
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Don't Replace Numbers Without Fixing Cause
- Low bicarbonate alone doesn't mean you should replace it; treat the underlying cause instead.
- In lactic acidosis the liver can regenerate bicarbonate when the cause is fixed.
Avoid Bicarbonate For Pure Lactic Acidosis
- Avoid using sodium bicarbonate to treat pure lactic acidosis; evidence suggests harm or no benefit.
- Continue focusing on diagnosing and reversing the cause of lactate accumulation instead.
AKI Subgroup Drove Positive Signals
- BICAR-ICU showed no difference in the primary composite outcome overall but signaled benefit in predefined AKI subgroup.
- The trial was underpowered so subgroup findings are hypothesis-generating, not definitive.