Sodium bicarbonate use in shock and cardiac arrest: attitudes of pediatric acute care physicians. (Teppa)

Parker MJ, Parshuram CS. Sodium Bicarbonate Use in Shock and Cardiac Arrest: Attitudes of Pediatric Acute Care Physicians*. Crit Care Med. 2013 Sep;41(9):2188-2195.

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.

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