Sodium bicarbonate therapy in severe metabolic acidemia: an individual patient data meta-analysis of the BICAR-ICU and BICAR-ICU2 trials
Pooled resultResult — go to the resultRelative risk 0.96 95% CI 0.86–1.07Authors' conclusion
Sodium bicarbonate therapy did not reduce overall 90-day mortality but decreased RRT use and suggested a mortality benefit in patients with the most profound acidemia (pH ≤ 7.10).
Study context
- Population
- Adults with severe metabolic acidemia (pH ≤ 7.20)
- Participants
- 1,016 adults · 2 RCTs
- Comparison
- IV sodium bicarbonate titrated to pH ≥ 7.30 vs no sodium bicarbonate
- Sodium bicarbonaten = 509
- Controln = 507reference
- Outcome
- Mortality
- Follow-up
- 90 days
Methodological detailsprespecified subgroup analyses
- Prespecified subgroup analyses
Pooled result
As reported in the abstract
Relative risk
0.96
95% CI 0.86–1.07
P = 0.51
By group
Sodium bicarbonate vs Control
RR 0.96 (95% CI 0.86–1.07); P = 0.51
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| 90-day mortality, pH ≤ 7.10 (subgroup) | 0.80 (0.68–0.93) | P = 0.004 | |
| 90-day mortality, pH > 7.10 (subgroup) | 1.05 (0.92–1.21) | P = 0.47 | |
| 0.512Relative risk (log scale) |
- 90-day mortality, pH ≤ 7.10 (subgroup): p-for-interaction = 0.006
- 90-day mortality, pH > 7.10 (subgroup): p-for-interaction = 0.006
90-day mortality by severe acute kidney injury (AKI) status and serum lactate (subgroups)
- No significant interaction for severe AKI status
- P for interaction = 0.11
- No significant interaction for serum lactate
- P for interaction = 0.22
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Sodium bicarbonate therapy in severe metabolic acidemia: an individual patient data meta-analysis of the BICAR-ICU and BICAR-ICU2 trials. Crit Care. Published 19 July 2026. doi:10.
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