Therefore, we had two aims in our study. First, we sought to describe the incidence of severely metabolic or mixed acidemia patients admitted to the ICU. Second, we wanted to describe the outcomes of patients who had been treated at the onset of acidemia (within the first 24 hours of ICU admission) with intravenous sodium bicarbonate compared 17-DMAG molecular weight with those who had not. We hypothesized that severe acidosis within the 24 first hours after ICU admission is an infrequent phenomenon but that its correction rather than its initial severity is associated with prognosis.Materials and methodsThis prospective, multiple-center study was conducted during a thirteen-month period in five ICUs. In accordance with French law, informed consent was not mandatory, given that this observational study did not modify diagnostic or therapeutic strategies.

This study was approved by the Montpellier University Hospital Institutional Review Board and followed the Strengthening the Reporting of Observational Studies in Epidemiology recommendations for reporting observational studies [17].Definitions”Severe acidemia” was defined as a pH below 7.20. Respiratory acidosis, metabolic acidosis and other mixed disorders were categorized using the classical method (namely, the Henderson-Hasselbalch equation) with base excess and corrected anion gap (AG) (corrected AG = (measured AG + (40 g/dl – (albuminemia �� 10 g/dl))) [3,18,19].Therefore, we defined the following specific acidemia as follows. (1) “Severe metabolic acidemia” comprised pH less than 7.

20, bicarbonatemia less than 22 mmol/L, base excess less than or equal to 5 mmol/L and expected partial pressure of carbon dioxide (PaCO2) = bicarbonatemia �� 1.5 + 8 �� 2 mmHg [18]. (2) “Severe respiratory acidemia” was defined as pH less than 7.20, PaCO2 greater than 45 mmHg and expected bicarbonatemia = (PaCO2 – 40) �� 10 + 24). (3) “Severe mixed acidemia” was the classification for secondary response to the primary process outside the expected range.PatientsAll consecutive patients who experienced severe acidemia within the first 24 hours of their ICU admission were screened, and those who presented with either single metabolic acidemia or mixed metabolic and respiratory acidemia were included. Patients admitted for diabetic ketoacidosis were excluded from the outcome analysis, as their mortality risk in the ICU is very low and may not represent the risk level among the whole population [20].

Furthermore, because one of the aims of the present study was to describe the use of sodium bicarbonate to treat severe acidemia, patients admitted with a single severe respiratory acidemia were not analyzed in detail, because they were considered not to be candidates for that treatment. No guidelines, advice or documentation were given Brefeldin_A to the intensivists regarding acidemia, treatment or routine daily care.