A groundbreaking multicenter trial involving 3,396 critically ill patients has challenged one of intensive care medicine’s longest-standing practices. The BICAR-ICU trial, published in The New England Journal of Medicine, found that intravenous sodium bicarbonate provided no survival benefit for patients with severe metabolic acidosis and circulatory shock compared to standard care alone.
Conducted across French intensive care units by researchers from Assistance Publique-Hôpitaux de Paris, the study represents the largest and most rigorous examination of bicarbonate therapy to date. With 28-day mortality rates nearly identical between treatment groups, the findings suggest that routine bicarbonate supplementation—a practice embedded in ICU protocols worldwide—may warrant reconsideration. Secondary endpoints including organ failure scores showed no meaningful improvement, further questioning the intervention’s clinical utility in this patient population.
These results signal an important moment for evidence-based practice revision in critical care medicine. Read the full article on GMJ Newsroom.
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