Department of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Melbourne, VIC, Australia.
Department of Intensive Care Medicine, Austin Hospital, Melbourne, VIC, Australia.
Crit Care Resusc. 2020 Mar;22(1):80-82. doi: 10.51893/2020.1.tn1.
Due to the lack of double-blind randomised controlled trials, the true effect of intravenous sodium bicarbonate therapy in ICU patients with metabolic acidosis remains unclear.
We diluted 100 mL 8.4% sodium bicarbonate in 150 mL 5% dextrose (D5W) within a 250 mL polyolefin bag after removing 100 mL. We asked ICU clinicians to inspect a 250 mL bag containing sodium bicarbonate or a 250 mL bag where 100 mL of D5W had been removed and then returned. The bags were attached to intravenous giving sets. We asked participants to identify the contents of the bags.
Among 60 participants (39 nursing staff [65%], 20 medical staff [33.3%] and one pharmacist), 36 (60%) answered correctly. The Cohen κ for agreement between test bag content and participants' answers was 0.20 (95% CI, -0.05 to 0.45; = 0.12), implying the answers were correct by chance. In the group of 28 participants who indicated they used a clue to help them decide their answer, 15 (53.6%) answered correctly, whereas in the remainder ( = 32), 21 (65.6%) answered correctly ( = 0.49).
When 100 mL of 8.4% sodium bicarbonate were diluted in 150 mL of D5W within a 250 mL polyolefin bag, clinicians were unable to correctly identify the contents of the bags. Our findings imply that sodium bicarbonate therapy can be successfully blinded.
由于缺乏双盲随机对照试验，静脉注射碳酸氢钠治疗 ICU 代谢性酸中毒患者的真实效果仍不清楚。
我们将 100mL8.4%碳酸氢钠在 250mL 聚烯烃袋中用 150mL5%葡萄糖（D5W）稀释，取出 100mL。我们请 ICU 临床医生检查一个装有碳酸氢钠的 250mL 袋或一个取出 100mL D5W 后又返回的 250mL 袋。这些袋子连接到静脉输液装置上。我们请参与者识别袋子的内容。
在 60 名参与者（39 名护理人员[65%]、20 名医务人员[33.3%]和一名药剂师）中，有 36 人（60%）回答正确。测试袋内容与参与者答案之间的 Cohen κ 一致性为 0.20（95%CI，-0.05 至 0.45； = 0.12），这意味着答案是随机正确的。在 28 名表示使用线索帮助他们做出回答的参与者中，有 15 名（53.6%）回答正确，而在其余的 32 名参与者中，有 21 名（65.6%）回答正确（ = 0.49）。
当 100mL8.4%碳酸氢钠在 250mL 聚烯烃袋中用 150mL5%D5W 稀释时，临床医生无法正确识别袋子的内容。我们的研究结果表明，碳酸氢钠治疗可以成功地进行盲法。
