A 67-year-old woman is admitted to the intensive care unit (ICU) for management of septic shock after emergency resection of a perforated colon. Arterial blood gas shows a pH of 7.18. Based on a recent prospective, randomized, open-label trial, administration of sodium bicarbonate to this patient is most likely to improve which of the following outcomes?
Treatment of acidotic patients with sodium bicarbonate is one of the longest-standing and least evidence-based ICU therapies. Although bicarbonate therapy will rapidly and predictably increase the pH in patients with metabolic acidosis, the actual impact on patient outcomes remains controversial. In theory, increasing the arterial pH will improve myocardial function, coagulation factor activity, and endothelial response to epinephrine, but it has been difficult to demonstrate a benefit in practice. This is partly because research in patients with heterogeneous critical illnesses is challenging and partly because the therapy may be more cosmetic than physiologic –...
