Comparison of two different bicarbonate replacement fluids during CVVH with RCA: a prospective, randomized, controlled trial

Le résumé fourni par la source

This study aimed to compare a high (HBF) and low (LBF) bicarbonate (HCO 3 − ) replacement fluid over 96 h after continuous veno-venous hemofiltration (CVVH) initiation using regional citrate anticoagulation to determine which fluid achieved better acid–base balance. In this prospective, randomized, controlled, open-label, cross-over, single-center trial, patients were randomized to initially receive either LBF (22 mmol/l HCO 3 − ) or HBF (30 mmol/l HCO 3 − ) for 48 h (first phase), followed by changing to the other fluid for a further 48 h (second phase). Intracorporeal pH and HCO 3 − changes were analyzed by calculating the rates of levels outside the standard values (excursion rates). Generalized estimating equations were performed to estimate the odds ratios for at least one pH/HCO 3 − excursion. Time to normalization within the first phase for pH and HCO 3 − was assessed using Kaplan–Meier curves and log-rank tests. A total of 88 patients were included. The rates for at least one pH and HCO 3 − excursion were higher in patients treated with HBF compared to LBF (pH: first phase 52% vs. 41%; second phase 48% vs. 34%; HCO 3 − : first phase 68% vs. 43%; second phase 73% vs. 43%). Adjusted odds ratios were 1.78 (95% CI 1.12–2.82; p = 0.015) for pH and 3.60 (95% CI 2.16–5.99; p < 0.001) for HCO 3 − . The time to normalization of pH in acidotic patients and of HCO 3 − in patients with low HCO 3 − did not differ significantly between HBF and LBF ( p = 0.102, p = 0.468). LBF showed significantly lower rates of pH and HCO 3 − excursions compared to HBF and no significant differences to the pH normalization in acidotic patients were observed. NCT04071171.

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