DOI: 10.32322/jhsm.1952665 ISSN: 2636-8579

The Stewart physicochemical approach to acid-base analysis: bibliometric mapping of the literature from 1978 to August 2026

Murat Kaykaç, Gözde Gürsoy Çirkinoğlu
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Aims: Since its introduction in 1978, the Stewart physicochemical approach has become an influential framework for acid-base interpretation in critical care, yet to our knowledge the global structure of its literature has not been systematically mapped. This study aimed to perform a comprehensive bibliometric analysis of the international Stewart literature and to identify intellectual landmarks, dominant research clusters, and emerging thematic directions.Methods: PubMed, Scopus, and the Web of Science Core Collection were searched on 23 August 2026 using an expanded strategy that combined eponymous, conceptual, and parameter-based terms. After deduplication and eligibility screening-with independent duplicate screening of a stratified sample by a second reviewer-1,141 unique publications spanning 1978 to August 2026 were retained. Analyses comprised publication trends, citation analysis, h-Index, Bradford’s and Lotka’s laws, co-citation, author keyword co-occurrence, country co-authorship, document type, and thematic evolution. Publication trends and document-type composition were analysed in the full corpus, whereas all citation-based, informetric, network, journal-level, keyword, and thematic analyses were performed on the Scopus subset (n=948; 83.1% of the corpus) in VOSviewer, with threshold sensitivity analyses.Results: Annual output rose from 4.8 publications per year in 1978-1992 to 39.3 per year during 2005-2019 and remained high thereafter (36.6 per year for 2020-2026). The Scopus subset accumulated 26,125 citations (h-Index 74; median 9.0 citations per publication). Stewart’s 1983 article was both the most cited publication (1,179 citations) and the most co-cited reference, cited in the reference lists of 416 of the 948 subset records (43.9%). Journal distribution conformed to Bradford’s law (20, 77, and 276 journals across the three zones; multipliers 3.85 and 3.58). Author productivity deviated significantly from Lotka’s inverse-square law (Kolmogorov-Smirnov D=0.095; critical value 0.032). Co-citation analysis identified three principal clusters-theoretical foundations, clinical application and prognostic markers, and fluid therapy-together with a small dyad representing methodological critique; cluster cores were invariant across thresholds. Country co-authorship comprised 30 countries (density 0.269), with the strongest axis between Canada and the United States. Keyword overlay showed a thematic shift from classical parameters (lactate, mean year 2008.2) toward fluid therapy (2017.9) and acid-base disorders (2016.2).Conclusion: The Stewart literature represents a mature but evolving research field, transitioning toward outcome-oriented and translational research. Its intellectual structure remains anchored to a small set of foundational references, whilst its collaborative structure is regionally clustered rather than consortium-based. The mapping identifies randomised designs (7.5% of the Scopus subset), economic evaluations (none identified), and inter-country collaboration as underrepresented in the current published record.

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