The Use of Sodium Bicarbonate in the Treatment of Acidosis in Sepsis: A Literature Update on a Long Term Debate

Table 1

Clinical studies evaluating bicarbonate use in sepsis patients with acidosis. Studies are listed in chronological order, based on year of publication.

Reference	Country, year	Study design	Results
Cooper et al. [1]	British Columbia, Canada, 1990	Prospective, randomized, blinded, crossover study, 14 patients	Sodium bicarbonate did not improve hemodynamics or the response to catecholamines and caused hypocalcemia and hypercarbia
Mathieu et al. [2]	Lille, France, 1991	Prospective, randomized, blinded, crossover study, 10 patients	Sodium bicarbonate increased arterial and venous pH, serum bicarbonate, and arterial and venous blood pCO2, but hemodynamic responses similar to sodium chloride
Fang et al. [3]	Nanjing, China, 2008	Prospective, randomized trial, 94 patients	5% sodium bicarbonate for resuscitation in severe sepsis with hypotension improved blood pressure and cardiac output earlier than saline or hypertonic sodium chloride, indicating limited benefit from bicarbonate in sepsis
Noritomi et al. [4]	Sao Paulo, Brazil, 2009	Prospective, observational study, 60 ICU patients with severe sepsis or septic shock	Lactate reduced and metabolic acidosis corrected in survivors, but not in nonsurvivors
El-Sholh et al. [5]	New York, USA, 2010	Retrospective study, 36 patients with septic shock who received bicarbonates versus 36 matched patients who did not	Bicarbonate group had shorter duration of mechanical ventilation but no difference in 28-day mortality
Jung et al. [6]	Montpellier, France, 2011	Prospective multicenter observational study, 200 patients with severe acidosis	Bicarbonate administration in 5–55% of patients, depending on center, not on acidosis mechanism. No association between bicarbonate and outcome
Chen et al. [8]	Jiangsu, China, 2013	Prospective, randomized trial, 65 patients	Patients who received bicarbonate had improved hemodynamics, shorter mechanical ventilation, shorter ICU and hospital stay, and lower mortality
Kim et al. [7]	Busan, Korea, 2013	Retrospective study, 103 patients with lactic acidosis	Bicarbonate use was independent risk factor for increased mortality