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Critical Care Medicine:
doi: 10.1097/CCM.0b013e31828a6669
Pediatric Critical Care

Sodium Bicarbonate Use in Shock and Cardiac Arrest: Attitudes of Pediatric Acute Care Physicians*

Parker, Melissa J. MD, MSc, FRCPC, FAAP (PCCM, PEM)1,2; Parshuram, Christopher S. Mb ChB, DPhil3–6

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Objectives: To evaluate the preferences and self-reported practices of pediatric acute care physicians with respect to sodium bicarbonate administration to infants and children in shock or cardiac arrest.

Design: National survey study utilizing a self-administered questionnaire.

Setting: Thirteen Canadian pediatric tertiary care centers.

Subjects: Canadian pediatric critical care physicians, pediatric emergency physicians, and trainees in these subspecialties.

Interventions: None.

Measurements and Main Results: Survey items were evaluated based on Yes/No responses, frequency responses, and Likert scales. Overall response rate was 53% (151/284) with 49.0% (74/151) citing pediatric critical care as their primary practice. 82.0% of respondents (123/150) indicated they would administer sodium bicarbonate as part of ongoing resuscitation for septic shock, whereas 58.3% (88/151) would administer sodium bicarbonate in a cardiac arrest scenario (p = 0.004). 47.3% (71/150) selected a pH threshold at or below which they would administer sodium bicarbonate (mean, 6.94 ± 0.013; median, 7.00; range, 6.50–7.20; interquartile range, 6.90–7.00), whereas 20.5% (31/151) selected a base excess threshold (mean, –15.62 ± 0.78; median, –16; range, –20 to –4; interquartile range, –20 to –14). Both pH and duration of resuscitation were strongly associated with the decision to administer sodium bicarbonate (p < 0.0001). Respondents’ perceptions regarding a colleague’s likelihood of administering sodium bicarbonate to the same patient under the same circumstances reflect an acknowledgment of disparate practices with respect to sodium bicarbonate use. 53.0% (79/149) felt current American Heart Association guidelines help them in deciding whether to administer sodium bicarbonate to critically ill patients, and 84% would support a randomized trial.

Conclusion: Differences of opinion exist among pediatric acute care physicians with respect to the timing and appropriateness of sodium bicarbonate administration during resuscitation. Most indicated they would support moving forward with a clinical trial. (Crit Care Med 2013; 41:2188–2195)

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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