Comparison of a modifed Story approach to traditional evaluation of acid–base disturbances in patients with shock: a cohort study

Abstract

To compare whether the diagnostic evaluation of metabolic acidosis can be improved by using a modifed Story method compared to the traditional evaluation in a population of critically ill patients with shock. This prospective cohort study included shock patients admitted to the ICU of a tertiary hospital in Brazil between May 2018 and November 2019. We collected laboratory data necessary for traditional evaluation and the simplifed Stewart’s method. During the study period, 149 patients were included in the fnal analysis. Of the 17 patients with a normal SBE and AGcorrected, 13 (76.5%) presented with metabolic acidosis according to the modifed Story assessment. Therefore, of the 149 patients included in the study, the traditional approach failed to identify metabolic acidosis that was identifed by the modifed Story assessment in 13 (8.7%) patients. In addition, the determination of the severity of metabolic acidosis also difered between the two methods by a mean of−7.8 mEq/L. We found that a modifed Story method can identify and quantify metabolic acidosis in patients with disorders that were not revealed by the traditional approach.