{
  "abstract": "Background: Two randomized trials (BICAR-ICU and BICAR-ICU2) evaluated intravenous sodium bicarbonate therapy in patients with severe metabolic acidemia but yielded inconclusive results. We performed an individual patient data meta-analysis to assess its effects on 90-day mortality and renal replacement therapy (RRT) use, and search for heterogeneity of treatment effects across prespecified subgroups. Methods: We performed an individual patient data meta-analysis of the BICAR-ICU and BICAR-ICU2 trials, including adults with severe metabolic acidemia (pH ≤ 7.20). Patients were randomized to receive intravenous sodium bicarbonate titrated to a pH ≥ 7.30 or no sodium bicarbonate. The primary outcome was 90-day mortality. Secondary outcomes included RRT initiation and dialysis-free days. Prespecified subgroup analyses explored treatment-effect heterogeneity by acidemia depth (pH ≤ 7.10 vs. > 7.10), severe acute kidney injury (AKI) status, and serum lactate (< 2mmol/L vs. ≥2mmol/L). Results: A total of 1,016 patients was included (509 sodium bicarbonate, 507 control). Sodium bicarbonate therapy did not significantly reduce 90-day mortality compared to control (58.3% vs. 60.6%; risk ratio [RR], 0.96; 95%CI, 0.86–1.07; p = 0.51). However, it significantly reduced RRT initiation (34.8% vs. 50.7%; RR, 0.69; 95%CI, 0.60–0.79; p < 0.001, number needed to treat: 6.3) and increased dialysis-free days (incidence rate ratio, 1.10; 95%CI, 1.06–1.14; p < 0.001). A significant interaction was observed with acidemia depth (p-for-interaction = 0.006): in patients with pH ≤ 7.10, sodium bicarbonate reduced 90-day mortality (RR, 0.80; 95%CI, 0.68–0.93; p = 0.004); no benefit was seen with pH > 7.10 (RR, 1.05; 95%CI, 0.92–1.21; p = 0.47). No significant interactions were observed for severe AKI status (p-for-interaction = 0.11) nor serum lactate (p-for-interaction = 0.22). Conclusions: 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). These findings invite a reconsideration of current paradigms, suggesting timely correction of severe metabolic acidemia to avoid RRT in some patients.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "name": "Maxime Fosset"
    },
    {
      "name": "Joris Pensier"
    },
    {
      "name": "Matthieu Jabaudon"
    },
    {
      "name": "Laurent Bitker"
    },
    {
      "name": "Audrey de Jong"
    },
    {
      "name": "Gerald Chanques"
    },
    {
      "name": "Helena Huguet"
    },
    {
      "name": "Nicolas Molinari"
    },
    {
      "name": "Samir Jaber"
    },
    {
      "name": "Boris Jung"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/btetbm06n953f.bib",
  "cited_by": 3,
  "doi": "10.1186/s13054-026-06206-3",
  "fulltext_url": null,
  "id": "btetbm06n953f",
  "issns": [
    "1364-8535",
    "1466-609X"
  ],
  "landing_url": "https://hal.science/hal-05702027v1",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "hal",
      "0.sdv"
    ],
    [
      "hal",
      "1.sdv.mhep"
    ],
    [
      "hal",
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    [
      "hal",
      "1.sdv.spee"
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      "2.sdv.mhep.em"
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    [
      "hal",
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    [
      "openalex",
      "2727|Renal function and acid-base balance"
    ]
  ],
  "openalex": "W7169719113",
  "pdf_url": "https://hal.science/hal-05702027/document",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-22",
  "publisher": "BioMed Central",
  "ris": "https://research.draconitic.com/paper/btetbm06n953f.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:59Z",
      "native_id": "hal-05702027",
      "source": "hal",
      "url": "https://hal.science/hal-05702027v1"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "hal:0.sdv",
      "subfield": "general"
    },
    {
      "field": "medicine",
      "origin": "hal:2.sdv.mhep.em",
      "subfield": "endocrinology-metabolism"
    },
    {
      "field": "medicine",
      "origin": "hal:1.sdv.spee",
      "subfield": "epidemiology-public-health"
    },
    {
      "field": "medicine",
      "origin": "hal:1.sdv.sp",
      "subfield": "pharmacology-toxicology"
    }
  ],
  "title": "Sodium bicarbonate therapy in severe metabolic acidemia: an individual patient data meta-analysis of the BICAR-ICU and BICAR-ICU2 trials",
  "title_text": "Sodium bicarbonate therapy in severe metabolic acidemia: an individual patient data meta-analysis of the BICAR-ICU and BICAR-ICU2 trials",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:59Z",
  "url": "https://research.draconitic.com/paper/btetbm06n953f",
  "venue": "Critical Care",
  "versions": []
}