Use of serum bicarbonate measurement in place of arterial base deficit in the surgical intensive care unit

Matthew J. Martin, Elizabeth FitzSullivan, Ali Salim, Thomas V. Berne, Shirin Towfigh, Steven C. Stain, Richard Mullins, Michael M. Shabot

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Hypothesis: Serum bicarbonate (HCO3) measurement may accurately and reliably be substituted for the arterial base deficit (BD) assay in the surgical intensive care unit (ICU). Design: Retrospective criterion standard analysis. Setting: Surgical ICU in a tertiary care facility. Patients: Consecutive sample of non-trauma-related surgical ICU admissions from January 1996 to January 2004 with simultaneously obtained serum HCO3 and arterial BD levels. Main Outcome Measures: Correlation between HCO3 and BD at admission and during the ICU stay; predictive value of serum HCO 3 for significant metabolic acidosis and ICU mortality. Results: The study included 2291 patients with 26 063 sets of paired laboratory data. The mean±SD age was 52±16 years and mean ICU stay was 5.8±9.8 days. There were 174 ICU deaths (8%). Serum HCO3 levels showed significant correlation with arterial BD levels both at admission (r=0.85, R2=0.72, P2=0.77, P3 reliably predicted the presence of significant metabolic acidosis (BD>5) with an area under the receiver operating characteristic curve (AUC) of 0.93 at admission and 0.95 overall (both P3 level predicted ICU mortality as accurately as the admission arterial BD (AUCs of 0.68 and 0.70, respectively) and more accurately than either admission pH or anion gap. Conclusions: Serum HCO3 provides equivalent information to the arterial BD and may be used as an alternative predictive marker or guide to resuscitation. Low HCO3 levels should prompt immediate metabolic acidosis evaluation and management.

Original languageEnglish (US)
Pages (from-to)745-751
Number of pages7
JournalArchives of Surgery
Volume140
Issue number8
DOIs
StatePublished - Aug 2005
Externally publishedYes

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Critical Care
Bicarbonates
Intensive Care Units
Serum
Acidosis
Area Under Curve
Acid-Base Equilibrium
Mortality
Tertiary Healthcare
Resuscitation
ROC Curve
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery

Cite this

Martin, M. J., FitzSullivan, E., Salim, A., Berne, T. V., Towfigh, S., Stain, S. C., ... Shabot, M. M. (2005). Use of serum bicarbonate measurement in place of arterial base deficit in the surgical intensive care unit. Archives of Surgery, 140(8), 745-751. https://doi.org/10.1001/archsurg.140.8.745

Use of serum bicarbonate measurement in place of arterial base deficit in the surgical intensive care unit. / Martin, Matthew J.; FitzSullivan, Elizabeth; Salim, Ali; Berne, Thomas V.; Towfigh, Shirin; Stain, Steven C.; Mullins, Richard; Shabot, Michael M.

In: Archives of Surgery, Vol. 140, No. 8, 08.2005, p. 745-751.

Research output: Contribution to journalArticle

Martin, MJ, FitzSullivan, E, Salim, A, Berne, TV, Towfigh, S, Stain, SC, Mullins, R & Shabot, MM 2005, 'Use of serum bicarbonate measurement in place of arterial base deficit in the surgical intensive care unit', Archives of Surgery, vol. 140, no. 8, pp. 745-751. https://doi.org/10.1001/archsurg.140.8.745
Martin, Matthew J. ; FitzSullivan, Elizabeth ; Salim, Ali ; Berne, Thomas V. ; Towfigh, Shirin ; Stain, Steven C. ; Mullins, Richard ; Shabot, Michael M. / Use of serum bicarbonate measurement in place of arterial base deficit in the surgical intensive care unit. In: Archives of Surgery. 2005 ; Vol. 140, No. 8. pp. 745-751.
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