Skip to main content
SpringerLink
Log in

Bicarbonate therapy in the treatment of septic shock: a second look

  • IM - Original
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

An Erratum to this article was published on 10 March 2010

Abstract

The use of supplemental sodium bicarbonate for the treatment of patients with septic shock and elevated blood lactate levels remains a controversial therapy. We conducted a retrospective study between March 2004 and February 2009 of 36 consecutive patients diagnosed with septic shock who received continuous infusion of bicarbonate therapy. A control group was matched 1:1 for age, site of infection, and predicted mortality by APACHE II. All patients were managed according to standard protocols. The median time until reversal of shock did not achieve statistical significance between the bicarbonate group (44.5 h [95% confidence interval [CI] 34–54] and the control group (55.0 h [95% CI 39–60] (p = 0.09). The median time to liberation of mechanical ventilation was significantly reduced in the bicarbonate group (10 days [95% CI 5.0–13.0] compared to the control group (14 days [95% CI 9.0–19.0], p = 0.02). The length of intensive care unit (ICU) stay was also shorter in the surviving patients who received bicarbonate compared to controls (median 11.5 days (95% CI 6.0–16.0) vs. 16.0 days (95% CI 13.5–19.0), respectively; p = 0.01). However, there was no difference in 28-day mortality between the two study groups (28%; 95% CI 14–45% vs. 33%; 95% CI 19–51%, respectively; p = 0.79). Infusion of sodium bicarbonate in septic patients with arterial hyperlactatemia may facilitate weaning from mechanical ventilation and reduce length of ICU stay.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348:1546–1554

    Article  PubMed  Google Scholar 

  2. Angus DC, Linde-Zwirble WT, Lidicker J (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310

    Article  CAS  PubMed  Google Scholar 

  3. Annane D, Sebille V, Charpeutier C et al (2002) Effect of treatment with low doses of hydrocortisone and fludricortisone on mortality in patients with septic shock. JAMA 288:862–871

    Article  CAS  PubMed  Google Scholar 

  4. Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377

    Article  CAS  PubMed  Google Scholar 

  5. Van den Berghe G, Wouters PJ, Weekers F et al (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345:1359–1367

    Article  PubMed  Google Scholar 

  6. Bernard GR, Vincent JL, Laterre P et al (2001) Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 344:699–709

    Article  CAS  PubMed  Google Scholar 

  7. Ellis W, Dodson M (1964) Severe septic shock treated successfully with sodium bicarbonate. J Bone Joint Surg Br 46:746–747

    CAS  PubMed  Google Scholar 

  8. Mathieu D, Neviere R, Billard V et al (1991) Effects of bicarbonate therapy on hemodynamics and tissue oxygenation in patients with lactic acidosis: a prospective, controlled clinical study. Crit Care Med 19:1352–1356

    Article  CAS  PubMed  Google Scholar 

  9. Cooper DJ, Walley KR, Wiggs BR et al (1990) Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med 112:492–498

    CAS  PubMed  Google Scholar 

  10. Fang ZX, Li YF, Zhou XQ et al (2008) Effects of resuscitation with crystalloid fluids on cardiac function in patients with severe sepsis. BMC Infect Dis 8:50

    Article  PubMed  Google Scholar 

  11. Warner A, Vaziri ND (1981) Treatment of lactic acidosis. South Med J 74:841–847

    CAS  PubMed  Google Scholar 

  12. Arieff AI, Leach W, Park R et al (1982) Systemic effects of NaHCO3 in experimental lactic acidosis in dogs. Am J Physiol 242:F59–F586

    Google Scholar 

  13. Tanaka M, Nishikawa T, Mizutani T (1996) Normovolemic hemodilution attenuates cardiac depression induced by sodium bicarbonate in canine metabolic acidosis. Br J Anaesth 77:408–412

    CAS  PubMed  Google Scholar 

  14. Tanaka M, Nishikawa T (1997) Acute haemodynamic effects of sodium bicarbonate administration in respiratory and metabolic acidosis in anaesthetized dogs. Anaesth Intensive Care 25:615–620

    CAS  PubMed  Google Scholar 

  15. Beech JS, Nolan KM, Iles RA et al (1994) The effects of sodium bicarbonate and a mixture of sodium bicarbonate and carbonate (Carbicarb) on skeletal muscle pH and hemodynamic status in rats with hypovolemic shock. Metabolism 43:518–522

    Article  CAS  PubMed  Google Scholar 

  16. Lang R, Fellner S, Neumann A et al (1988) Left ventricular contractility varies directly with blood ionized calcium. Ann Intern Med 108:524–529

    CAS  PubMed  Google Scholar 

  17. American College of Chest Physicians/Society of Critical Care Consensus Conference (1992) Definitions for sepsis and multiple organ failure. Crit Care Med 20:864–874

    Article  Google Scholar 

  18. El Solh A, Akinnusi M, Alsawalha L et al (2008) Outcome of septic shock in older adults following the implementation of the sepsis bundle. J Am Geriatr Soc 56:272–278

    Article  PubMed  Google Scholar 

  19. El Solh A, Aquilina A, Pineda L et al (2006) Noninvasive ventilation for prevention of post extubation respiratory failure in obese patients. Eur Respir J 28:1–8

    Article  Google Scholar 

  20. Knaus WA, Draper EA, Wagner DP et al (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Article  CAS  PubMed  Google Scholar 

  21. Rubin D (1996) Multiple imputation after 18+ years. J Am Stat Assoc 91:473–489

    Article  Google Scholar 

  22. Wildenthal K, Mierzwiak D, Myers R et al (1968) Effects of acute lactic acidosis on left ventricular performance. Am J Physiol 214:1352–1359

    CAS  PubMed  Google Scholar 

  23. von Planta I, Weil MH, von Planta M et al (1991) Hypercarbic acidosis reduces cardiac resuscitability. Crit Care Med 19:1177–1182

    Article  Google Scholar 

  24. Kerber RE, Pandian NG, Hoyt R et al (1983) Effect of ischemia, hypertrophy, hypoxia, acidosis, and alkalosis on canine defibrillation. Am J Physiol 244:H825–H883

    CAS  PubMed  Google Scholar 

  25. Orchard C, Kentish J (1990) Effects of changes of pH on the contractile function of cardiac muscle. Am J Physiol 258:C967–C981

    CAS  PubMed  Google Scholar 

  26. Zhang YS, Liu QS, Yin GQ et al (1999) Effect of 5% sodium bicarbonate perfusion at different dose on cardiac function in rabbits with infective shock by meningococcus. J Nanjing Railway Med Coll 18:148–151

    Google Scholar 

  27. Gossett KA, French DD, Cleghorn B et al (1990) Blood biochemical response to sodium bicarbonate infusion during sublethal endotoxemia in ponies. Am J Vet Res 51:1370–1374

    CAS  PubMed  Google Scholar 

  28. Kreger BE, Craven DE, McCabe WR (1980) Gram-negative bacteremia: re-evaluation of clinical features and treatment in 612 patients. Am J Med 68:344–345

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. The Veterans Affairs Western New York Healthcare System, Medical Research Blg 20 (151) VISN02, 3495 Bailey Avenue, Buffalo, NY, 14215-1199, USA

    Ali A. El-Solh

  2. Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Western New York Respiratory Research Center, Buffalo, NY, USA

    Ali A. El-Solh & Philippe Abou Jaoude

  3. Department of Social and Preventive Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA

    Ali A. El-Solh

  4. Department of Anesthesia, State University of New York at Buffalo School of Medicine and Biomedical Sciences and School of Public Health and Health Professions, Buffalo, NY, USA

    Jahan Porhomayon

Authors
  1. Ali A. El-Solh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philippe Abou Jaoude
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jahan Porhomayon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ali A. El-Solh.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s11739-010-0372-y

Rights and permissions

Reprints and permissions

About this article

Cite this article

El-Solh, A.A., Abou Jaoude, P. & Porhomayon, J. Bicarbonate therapy in the treatment of septic shock: a second look. Intern Emerg Med 5, 341–347 (2010). https://doi.org/10.1007/s11739-010-0351-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-010-0351-3

Keywords

Search

Navigation