Sodium bicarbonate administration for metabolic acidosis in the intensive care unit: a target trial emulation
Authors' conclusion
In this target trial emulation, bicarbonate administration was associated with a small but statistically significant reduction in mortality for patients with metabolic acidosis.
Study context
- Population
- Adult ICU patients with metabolic acidosis (pH < 7.3 and PCO2 ≤ 45 mmHg within the first three days), 12 Australian intensive care units (ICUs); excluding repeat admissions, toxicology, diabetic ketoacidosis, pre-existing end-stage renal failure
- Participants
- 6,157 eligible admissions
- Exposure
- Sodium bicarbonate vs no sodium bicarbonate
- Sodium bicarbonaten = 1,764
- Outcome
- ICU mortality with ICU discharge as a competing event
- Follow-up
- 30 days
Methodological detailstarget trial emulation, multicentre, parametric g-computation, rolling entry matching sensitivity analysis
- Target trial emulation
- Multicentre
- Parametric g-computation
- Rolling entry matching sensitivity analysis
Main finding
As reported in the abstract
30-day ICU mortality (ICU discharge as competing event)
Absolute mortality reduction with bicarbonate therapy (primary analysis)
1.9%
Risk ratio, bicarbonate therapy
0.86
95% CI 0.80 to 0.91
Observational data: associations, not effects.
Further findings
30-day ICU mortality, subgroups (AKI, vasoactive therapy, pH < 7.2)
- Significant benefits with bicarbonate therapy across all subgroups evaluated
30-day ICU mortality, sensitivity analysis (rolling entry matching)
- Absolute mortality reduction with bicarbonate therapy (similar point estimate)
- 2.1%
- Sustained mortality reduction at 30 days
- Sensitivity analysis
Original publication
Sodium bicarbonate administration for metabolic acidosis in the intensive care unit: a target trial emulation. Intensive Care Med. Published 10 June 2025. doi:10.
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