Journal Club - BICAR-ICU: "Ok Bicarb, I-C-U"

Jaber S, Paugam C, Futier E, Lefrant JY, Lasocki S, Lescot T, Pottecher J, Demoule A, Ferrandière M, Asehnoune K, Dellamonica J, Velly L, Abback PS, de Jong A, Brunot V, Belafia F, Roquilly A, Chanques G, Muller L, Constantin JM, Bertet H, Klouche K, Molinari N, Jung B; BICAR-ICU Study Group. Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial. Lancet. 2018 Jul 7;392(10141):31-40. doi: 10.1016/S0140-6736(18)31080-8. Epub 2018 Jun 14. Erratum in: Lancet. 2018 Dec 8;392(10163):2440. PMID: 29910040.

This multi centered, open label, phase 3 clinical trial assessed the 28 day mortality effects of initiating sodium bicarbonate therapy for patients with severe metabolic acidaemia in the ICU. The study showed no direct benefit on the all cause 28 day mortality, but there were findings suggesting that early initiation could decreased 28 day renal injury and defer CRRT in some patients.

Matsue Y, Damman K, Voors AA, Kagiyama N, Yamaguchi T, Kuroda S, Okumura T, Kida K, Mizuno A, Oishi S, Inuzuka Y, Akiyama E, Matsukawa R, Kato K, Suzuki S, Naruke T, Yoshioka K, Miyoshi T, Baba Y, Yamamoto M, Murai K, Mizutani K, Yoshida K, Kitai T. Time-to-Furosemide Treatment and Mortality in Patients Hospitalized With Acute Heart Failure. J Am Coll Cardiol. 2017 Jun 27;69(25):3042-3051. doi: 10.1016/j.jacc.2017.04.042. PMID: 28641794.\

This prospective multicenter, observational cohort study of patients presenting to the ED for AHF assessed wether earlier administration of furosemide of any dose would improve in-hospital mortality. Ultimately the study suggested that early treatment with intravenous loop diuretics was in fact associated with lower in-hospital mortality, however this study does include a large level of physician gestalt in determining AHF presentation immediately on arrival and would recommend erring on your comfortably with the diagnoses before reflexively adding a loop diuretic.

October Journal Club Discussion Leader: Nicholas Cooper, MD (PGY-2)

2021-2022 Academic Year Journal Club Leaders: Rose Solomon, MD (PGY-3); Jarred Worthy, DO (PGY-2); David Andonian, MD (Faculty Advisor)