What question did this study set out to answer?

The aim is to evaluate the effects of sodium bicarbonate on critically ill patients with acute metabolic acidosis.

May 24, 2026

Sodium Bicarbonate for Acute Metabolic Acidosis in Critically Ill Adults: A Meta-Analysis of Randomized Clinical Trials

Puntos clave

The aim is to evaluate the effects of sodium bicarbonate on critically ill patients with acute metabolic acidosis.
Systematic search of databases for randomized controlled trials comparing sodium bicarbonate with placebo.
Inclusion of four trials with a total of 1,111 patients.
Performing Hartung-Knapp meta-analyses and Bayesian analyses for outcomes.
Sodium bicarbonate reduced renal replacement therapy use with a risk ratio (RR) of 0.69 (95% CI, 0.61-0.78).
Mortality showed a nonsignificant trend with an RR of 0.84 (95% CI, 0.55-1.30).
Bayesian analysis indicated a 90.4% probability of any mortality reduction alongside a 94.6% probability of reduced RRT use.

Resumen

OBJECTIVES: Acute metabolic acidosis is frequent in critical illness and may be managed with volume replacement therapy, sodium bicarbonate, and renal replacement therapy (RRT). BICARICU-1 and BICARICU-2 trials provided new evidence on bicarbonate therapy. We aimed to systematically evaluate the effects of sodium bicarbonate in critically ill patients. DATA SOURCES: We systematically searched PubMed, Embase, Medline, and the Cochrane Library for randomized controlled trials (RCTs) evaluating sodium bicarbonate vs. placebo in critically ill adults with acute metabolic acidosis. STUDY SELECTION: Only RCTs were selected. DATA EXTRACTION: Primary outcome was RRT; secondary outcomes were mortality, ICU length of stay, ventilator-free days, and vasopressor-free days. DATA SYNTHESIS: We performed Hartung-Knapp random-effects meta-analyses and trial sequential analysis (TSA) for primary outcomes. Bayesian random-effects meta-analyses with noninformative and weakly informative priors were used for sensitivity analysis. Four trials enrolling 1,111 patients were included. Sodium bicarbonate showed a nonsignificant trend toward lower mortality (risk ratio RR, 0.84; 95% CI, 0.55-1.30); TSA indicated that the cumulative sample size remained far below the required information size, and the mortality effect is inconclusive. Sodium bicarbonate significantly reduced RRT use (RR, 0.69; 95% CI, 0.61-0.78), and TSA supported firm evidence of benefit. Bayesian analyses estimated posterior probabilities of any mortality reduction (RR < 1) and reduced RRT use of 90.4% and 94.6%, respectively. Secondary outcomes remained imprecise, with a trend of toward more vasopressor-free days. CONCLUSIONS: In critically ill adults with acute metabolic acidosis, sodium bicarbonate significantly reduces RRT requirement, with Bayesian analyses suggesting a possibility of mortality benefit, although current evidence remains inconclusive. Larger RCTs or high-quality real-world studies are needed to confirm efficacy of sodium bicarbonate for mortality.

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