New evidence from the BICAR-ICU trial reveals striking mortality statistics that question the efficacy of sodium bicarbonate therapy in critical illness. Among 3,396 enrolled patients with metabolic acidosis and shock, 28-day mortality reached 32.7% in the bicarbonate-treated group versus 31.5% in standard care patients—a negligible 1.2% absolute difference with no statistical significance.
This landmark randomized controlled trial, published in The New England Journal of Medicine, provides definitive data on an intervention that has been routinely administered across intensive care units for decades. The absence of mortality benefit persisted despite bicarbonate’s theoretical mechanism of acid-base correction. Secondary outcomes, including organ dysfunction scores, similarly demonstrated no meaningful improvement. These findings represent a critical data point for clinicians reassessing treatment protocols and suggest that alternative or supportive strategies may deserve greater emphasis in managing acidemic critically ill patients.
Read the full article on GMJ Newsroom.
Was this article helpful?
