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

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.