Document Detail


Serum bicarbonate may replace the arterial base deficit in the trauma intensive care unit.
MedLine Citation:
PMID:  16307950     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Arterial base deficit (BD) is a commonly used marker of injury severity and endpoint of resuscitation but requires an arterial puncture and blood gas analysis. Serum bicarbonate (HCO3) is routinely obtained as part of the chemistry panel on most admissions. We hypothesized that serum HCO3 strongly correlates with arterial BD and provides equivalent predictive information. METHODS: All trauma ICU admissions from 1996 to 2004 with simultaneously obtained serum chemistry panels and arterial blood gases were identified. Correlation between BD and HCO3 was analyzed by using linear regression, and predictive abilities for acidoses and mortality were compared using the area under the respective receiver operating characteristic curve (AUC). Separate analyses were done for the entire dataset and the subset of ICU admission laboratory values. RESULTS: We identified 3,102 patients with 50,311 matched pairs of laboratory data. Serum HCO3 showed a significant linear correlation with BD for all laboratory sets (r = 0.85, P < .01) and admission laboratory values only (r = 0.80, P < .01). Serum HCO3 reliably predicted the presence of significant metabolic acidoses (BD >5), with an AUC of 0.96 (P < .01), which clearly outperformed pH (AUC = 0.83), anion gap (AUC = 0.7), and lactate (AUC = 0.73). The mean admission BD among survivors was 2.5 versus 5.2 for nonsurvivors (P < .01), and the mean HCO3 was 17.7 versus 19.8 (P < .01). The admission HCO3 identified nonsurvivors as accurately as BD (AUCs of 0.66 and 0.68) and more accurately than either pH (AUC = 0.53) or anion gap (AUC = 0.6). CONCLUSION: Serum HCO3 measurement shows a strong linear correlation and similar predictive ability compared with the arterial BD. Serum HCO3 may be safely and accurately substituted for arterial BD measurement in critically injured patients.
Authors:
Elizabeth FitzSullivan; Ali Salim; Demetrios Demetriades; Juan Asensio; Matthew J Martin
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American journal of surgery     Volume:  190     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-11-25     Completed Date:  2006-01-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  941-6     Citation Subset:  AIM; IM    
Affiliation:
Division of Trauma and Surgical Critical Care, Keck School of Medicine, University of Southern California and the Los Angeles County + USC Medical Center, 1200 North State Street, Room 10-750, Los Angeles, CA 90033, USA.
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MeSH Terms
Descriptor/Qualifier:
Acidosis / diagnosis*,  etiology
Adult
Bicarbonates / blood*
Biological Markers / blood
Blood Gas Analysis
Female
Humans
Intensive Care Units*
Male
Predictive Value of Tests
ROC Curve
Reproducibility of Results
Resuscitation
Retrospective Studies
Trauma Centers
Trauma Severity Indices
Wounds and Injuries / blood*,  complications,  therapy
Chemical
Reg. No./Substance:
0/Bicarbonates; 0/Biological Markers

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