An IV Sodium Bicarbonate Shortage in the Critically Ill: An Interrupted Time-Series Analysis
Bibliographic record
Abstract
OBJECTIVE: To examine effects of the 2017 worldwide shortage of IV sodium bicarbonate on outcomes of critically ill adults with acidemia. DESIGN: Interrupted time-series analysis. SETTING: Seventeen adult ICUs in Alberta, Canada. PATIENTS: Adults (≥ 18 yr) with blood pH value of less than 7.3, admitted to study ICUs between June 1, 2015, and 31 December 2019. INTERVENTIONS: The 2017 sodium bicarbonate shortage occurred between 8 June and October 4, 2017. Our health authority enacted emergency conservation measures during this time. MEASUREMENTS AND MAIN RESULTS: The main data source was eCritical Alberta, a population-based ICU Registry. The primary outcome was the proportion of patients treated with IV sodium bicarbonate. Outcomes were examined via segmented regression. Among 18,865 admissions, median age was 62 years (interquartile range [IQR] 50-71), median Acute Physiology and Chronic Health Evaluation (APACHE) II was 23 (IQR 18-30), and 39.6% were female. Immediately after start of the shortage, patients treated with bicarbonate decreased from 29.3% to 21.5% (absolute -7.8%; 95% CI, -12.8 to -2.8%). During the shortage bicarbonate recipients more likely had pH less than or equal to 7.20 (78.8% vs. 69.0%, p < 0.01). Subgroup analysis among those with pH less than or equal to 7.20 who did not receive bicarbonate during the shortage suggested increased proportion treated with vasopressors (9.9%; 95% CI, 2.4-17.4%) and continuous renal replacement therapy (8.6%; 95% CI, 0.6-16.6%). Similar trends were observed among those with renal sequential organ failure assessment greater than or equal to 3 who did not receive bicarbonate during the shortage. There was no change in ICU length of stay or mortality in overall population or subgroups. CONCLUSIONS: Emergency conservation measures that accompanied a worldwide shortage of IV sodium bicarbonate were associated with a reduction in IV sodium bicarbonate use among critically ill patients with acidemia. This was not linked to changes in survival or length of stay outcomes. Future bicarbonate research should focus on subgroups such as those with severe acidemia and/or advanced renal insufficiency.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".