<scp>ICU</scp> mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia

Bihari, Shailesh; Prakash, Shivesh; Peake, Sandra; Bailey, Michael; Pilcher, David; Bersten, Andrew D.

doi:10.1111/resp.13055

Cited by 11 publications

(11 citation statements)

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“…Our study was not powered to examine any of the patient centred outcomes, but it does provide data for future studies examining these and, moreover, shows that inducing hypernatremia is both safe and feasible in ARDS patients. This study, therefore, provides credence to previous epidemiological findings of a differential effect of hypernatremia in patients with possible lung injury [ 16 , 17 ].…”

Section: Discussionsupporting

confidence: 85%

“…Current evidence suggests that an increase in plasma sodium and osmolarity is associated with worse patient outcomes [ 10 – 15 ]. However, this was not the case in patients admitted to the ICU with respiratory diagnoses, or those with possible lung injury and hypoxia requiring mechanical ventilation [ 16 , 17 ], suggesting a possible protective effect.…”

Section: Introductionmentioning

confidence: 99%

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Induced hypernatremia in patients with moderate-to-severe ARDS: a randomized controlled study

Bihari

Prakash

Dixon

et al. 2021

ICMx

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Background Induced hypernatremia and hyperosmolarity is protective in animal models of lung injury. We hypothesized that increasing and maintaining plasma sodium between 145 and 150 mmol/l in patients with moderate-to-severe ARDS would be safe and will reduce lung injury. This was a prospective randomized feasibility study in moderate-to-severe ARDS, comparing standard care with intravenous hypertonic saline to achieve and maintain plasma sodium between 145 and 150 mmol/l for 7 days (HTS group). Both groups of patients were managed with lung protective ventilation and conservative fluid management. The primary outcome was 1-point reduction in lung injury score (LIS) or successful extubation by day 7. Results Forty patients were randomized with 20 in each group. Baseline characteristics of severity of illness were well balanced. Patients in the HTS group had higher plasma sodium levels during the first 7 days after randomization when compared with the control group (p = 0.04). Seventy five percent (15/20) of patients in the HTS group were extubated or had ≥ 1-point reduction in LIS compared with 35% (7/20) in the control group (p = 0.02). There was also a decrease in length of mechanical ventilation and hospital length of stay in the HTS group. Conclusion We have shown clinical improvement in patients with moderate-to-severe ARDS following induced hypernatremia, suggesting that administration of hypertonic saline is a safe and feasible intervention in patients with moderate-to-severe ARDS. This suggests progress to a phase II study. Clinical Trial Registration Australian and New Zealand Clinical Trials Registry (ACTRN12615001282572)

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Induced hypernatremia in patients with moderate-to-severe ARDS: a randomized controlled study

Bihari

Prakash

Dixon

et al. 2021

ICMx

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“… 10 In critically ill patients with serum osmolarity over 300 mmol/L, increased mortality has been reported in patients with cardiac, cerebral, vascular, and gastrointestinal admission diagnoses, but not in those with respiratory disease. 11 , 12 …”

Section: Introductionmentioning

confidence: 99%

The Contribution of Plasma Urea to Total Osmolality During Iatrogenic Fluid Reduction in Critically Ill Patients

et al. 2021

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Hyperosmolality is common in critically ill patients during body fluid volume reduction. It is unknown whether this is only a result of decreased total body water, or an active osmole-producing mechanism similar to that in aestivating animals where muscle degradation increases urea levels to preserve water. We hypothesized that fluid volume reduction in critically ill patients contributes to a shift from ionic to organic osmolytes similar to mechanisms of aestivation. We performed a post-hoc analysis on data from a multicenter observational study in adult ICU patients in the post-resuscitative phase. Fluid, electrolyte, energy and nitrogen intake, fluid loss, estimated glomerular filtration rate (eGFR) and estimated plasma osmolality (eOSM) were registered. Contributions of osmolytes Na+, K+, urea and glucose to eOSM expressed as proportions of eOSM were calculated. 241 patients were included. eOSM increased (median change 7.4 mOsm/kg (IQR −1.9–18) during the study. The of sodium's and potassium's proportions of eOSM decreased (P < 0.05 and P < 0.01 respectively), whereas the urea's proportion increased (P < 0.001). Urea's proportion of eOSM was higher in patients with negative vs. positive fluid balance. The urea's proportion of eOSM increased with eOSM (r = 0.63; adjusted for eGFR r = 0.80), but not nitrogen intake. In patients without furosemide and/or renal replacement therapy (n = 17), urea's proportion of eOSM and eOSM correlated strongly (r = 0.92). Urea's proportion of eOsm was higher in patients not surviving to 90 days. In stabilized ICU patients the contribution of urea to plasma osmolality increased during body water volume reduction, statistically independently of nitrogen administration and eGFR. The shift from ionic osmolytes to urea during body fluid volume reduction is similar to that seen in aestivating animals. ClinicalTrials.org Identifier: NCT03972475

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confidence: 91%

“…2 Perturbation of osmolarity is strongly associated with fluid-electrolyte imbalances, such as dehydration and hypernatremia, leading to adverse consequences such as increased risk of cardiovascular, cerebral, respiratory and renal disorders, and mortality. [3][4][5][6][7] The Yildiz et al 1 study extended this observation to cardiovascular diseases, especially STEMI undergoing pPCI.Contrast-induced nephropathy represents a significant adverse event of contrast medium administration, leading to worse clinical outcomes despite successful coronary revascularization. 8 The mechanisms causing CIN remain poorly understood.…”

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confidence: 97%

Serum Osmolarity and Contrast-Induced Nephropathy

et al. 2019

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We read with interest the article by Yildiz et al entitled "Association of serum osmolarity with contrast-induced nephropathy (CIN) in patients with ST-segment elevation myocardial infarction." 1 The authors identified serum hyperosmolarity as a risk factor for CIN development in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI).Serum osmolarity plays an important role in extracellular and intracellular water distribution and mainly depends on the concentrations of sodium (Na þ ), potassium (K þ ), chlorine (Cl -), glucose, and urea. 2 Perturbation of osmolarity is strongly associated with fluid-electrolyte imbalances, such as dehydration and hypernatremia, leading to adverse consequences such as increased risk of cardiovascular, cerebral, respiratory and renal disorders, and mortality. [3][4][5][6][7] The Yildiz et al 1 study extended this observation to cardiovascular diseases, especially STEMI undergoing pPCI.Contrast-induced nephropathy represents a significant adverse event of contrast medium administration, leading to worse clinical outcomes despite successful coronary revascularization. 8 The mechanisms causing CIN remain poorly understood. Probably several mechanisms are involved, revealing a complex multifactorial physiopathology with a interindividual variability. 9 Preexisting renal impairment, metabolic syndrome, congestive heart failure, peripheral artery disease, older age, anemia, diabetes, and the use of large contrast medium volumes may be risk factors for the development of CIN. 10 Many available biomarkers such as homocysteine, procalcitonin, high-sensitivity C-reactive protein, N-terminal pro-brain natriuretic peptide, red cell distribution width, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, monocyte to highdensity lipoprotein ratio, and fibrinogen to albumin ratio (FAR) have been shown to predict CIN development. [11][12][13][14][15][16][17][18][19] In the study by Yildiz et al, 1 serum osmolarity, hemoglobin, contrast media volume, creatinine on admission, basal SYNergy between PCI with TAXus and cardiac surgery II score, and left ventricular ejection fraction were found to be independent predictors of CIN. However, serum osmolarity only had a modest predictive accuracy for CIN in this analysis. Risk estimation for CIN should not be based solely on serum osmolarity; all relevant predictors of CIN should be considered during clinical decision-making. To improve the accuracy for predicting CIN, further studies should be focused on the combined information of several biomarkers and related scores. ORCID iDQi Hua

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ICU mortality is increased with high admission serum osmolarity in all patients other than those admitted with pulmonary diseases and hypoxia

Abstract: High admission serum osmolarity was not associated with increased odds for ICU death in pulmonary patients, unlike other subgroup of patients, and could be a potential area for future interventional therapy.

Cited by 11 publications

References 43 publications

Induced hypernatremia in patients with moderate-to-severe ARDS: a randomized controlled study

Induced hypernatremia in patients with moderate-to-severe ARDS: a randomized controlled study

The Contribution of Plasma Urea to Total Osmolality During Iatrogenic Fluid Reduction in Critically Ill Patients

Serum Osmolarity and Contrast-Induced Nephropathy

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