• Ary Serpa Neto, Tomoko Fujii, Mairead McNamara, James Moore, Paul J Young, Sandra Peake, Michael Bailey, Carol Hodgson, Alisa M Higgins, Emily J See, Paul Secombe, Lewis Campbell, Meredith Young, Mikihiro Maeda, David Pilcher, Alistair Nichol, Adam Deane, Elisa Licari, Kyle White, Craig French, Yahya Shehabi, Anthony Cross, Matthew Maiden, Umesh Kadam, Khaled El Khawas, Jamie Cooper, Rinaldo Bellomo, and Andrew Udy.
• Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, VC, Australia.
• Crit. Care Med. 2023 Nov 1; 51 (11): e221e233e221-e233.

ObjectivesTo identify the best population, design of the intervention, and to assess between-group biochemical separation, in preparation for a future phase III trial.DesignInvestigator-initiated, parallel-group, pilot randomized double-blind trial.SettingEight ICUs in Australia, New Zealand, and Japan, with participants recruited from April 2021 to August 2022.PatientsThirty patients greater than or equal to 18 years, within 48 hours of admission to the ICU, receiving a vasopressor, and with metabolic acidosis (pH < 7.30, base excess [BE] < -4 mEq/L, and Pa co2 < 45 mm Hg).InterventionsSodium bicarbonate or placebo (5% dextrose).Measurements And Main ResultThe primary feasibility aim was to assess eligibility, recruitment rate, protocol compliance, and acid-base group separation. The primary clinical outcome was the number of hours alive and free of vasopressors on day 7. The recruitment rate and the enrollment-to-screening ratio were 1.9 patients per month and 0.13 patients, respectively. Time until BE correction (median difference, -45.86 [95% CI, -63.11 to -28.61] hr; p < 0.001) and pH correction (median difference, -10.69 [95% CI, -19.16 to -2.22] hr; p = 0.020) were shorter in the sodium bicarbonate group, and mean bicarbonate levels in the first 24 hours were higher (median difference, 6.50 [95% CI, 4.18 to 8.82] mmol/L; p < 0.001). Seven days after randomization, patients in the sodium bicarbonate and placebo group had a median of 132.2 (85.6-139.1) and 97.1 (69.3-132.4) hours alive and free of vasopressor, respectively (median difference, 35.07 [95% CI, -9.14 to 79.28]; p = 0.131). Recurrence of metabolic acidosis in the first 7 days of follow-up was lower in the sodium bicarbonate group (3 [20.0%] vs. 15 [100.0%]; p < 0.001). No adverse events were reported.ConclusionsThe findings confirm the feasibility of a larger phase III sodium bicarbonate trial; eligibility criteria may require modification to facilitate recruitment.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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