Sodium Bicarbonate May Improve Outcome in Children With Life-Threatening Asthma

Laurie Barclay, MD

March 07, 2005

March 7, 2005 — Sodium bicarbonate can improve outcome in children with life-threatening asthma (LTA), according to the results of a retrospective study published in the March issue of Chest.

"It was postulated that children with LTA could benefit from treating their acidosis, as this would lead to a better effect of beta-agonists," write Corinne M. P. Buysse, MD, from Erasmus MC-Sophia Children's Hospital in Rotterdam, the Netherlands, and colleagues. "A potential risk of sodium bicarbonate infusion is a pCO 2 rise because of increased production, inadequate gas exchange, and hypoventilation."

At a pediatric intensive care unit (PICU) of a tertiary care university hospital, 17 children with LTA received sodium bicarbonate since January 1999, when a new protocol was initiated, incorporating the use of intravenous sodium bicarbonate in acidotic patients (pH < 7.15) with refractory status asthmaticus. Of these 17 children, five received two or three doses of sodium bicarbonate, and three children received sodium bicarbonate after intubation.

Five patients underwent intubation and mechanical ventilation before admission to the PICU, and one patient had these interventions during admission. After sodium bicarbonate infusion, pCO 2 levels decreased ( P = .007), and all but one patient had an improvement in respiratory distress.

Study limitations include retrospective design, small sample size, and lack of lung function tests or a scoring system to assess the severity of asthma before and after the administration of sodium bicarbonate.

"Sodium bicarbonate might be useful as an adjunctive treatment in patients with LTA and acidosis in whom mechanical ventilation is considered," the authors write. "The fear for an increase in pCO 2 is unsubstantiated. Further prospective randomized trials with sodium bicarbonate in this setting are warranted."

Chest. 2005;137:866-870

Reviewed by Gary D. Vogin, MD

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