Abstract 123: Sodium Bicarbonate Use in Pediatric Shock and Cardiac Arrest: Attitudes of Pediatric Acute Care Physicians
Introduction: AHA recommendations suggest Sodium Bicarbonate may be administered to infants and children in shock or cardiac arrest.
Hypothesis: That there would be heterogeneity of stated practices regarding sodium bicarbonate administration among pediatric acute care physicians.
Methods: We conducted a survey study of Canadian Pediatric Acute Care Physicians (Pediatric Intensivists, Pediatric Emergency Physicians, and subspecialty trainees) to evaluate their stated practices and beliefs regarding sodium bicarbonate administration. A 10-minute scenario-based survey evaluated preferences regarding sodium bicarbonate administration.
Results: Surveys were returned by 120/284 (42%). Respondents cited Intensive Care 57 (47.5%) and Emergency 54 (45%) as primary practice areas while 50 (42%) had been staff >10 years and 22 (18.3%) were trainees. Sodium bicarbonate would be ordered by 97 (82%) of respondents for a child with evolving septic shock and by 71 (59.1%) of respondents for a child in cardiac arrest (p=0.02). The following generic indications for giving sodium bicarbonate were considered important (>7/10) by respondents: arterial pH 63 (52.5%), hyperkalemia 63 (54.2%), working diagnosis 104 (87.4%), and base excess 31 (26.7%). The following adverse effects were considered important (>7/10) by respondents: paradoxical acidosis 64 (55%), hypercarbia 39 (33%), and hypernatremia 27 (23%). In septic shock a pH threshold of median (IQR) 7 (6.9–7.0) was identified by 57 (47.9%) of respondents while only 26 (21.7%) of respondents identified a threshold base-excess of median (IQR) −16 (−20 to −14). Most 112 (93%) reported familiarity with AHA guidelines and 61 (54%) felt current guidelines helped them in deciding whether to administer sodium bicarbonate to critically ill patients. Pediatric acute care physicians 98 (83%) indicated a willingness to enroll patients in a randomized controlled trial evaluating the use of sodium bicarbonate in patients in shock.
Conclusions: The stated practices and beliefs regarding sodium bicarbonate administration are heterogeneous among pediatric acute care physicians. Most would support a randomized controlled trial.
- © 2010 by American Heart Association, Inc.