Treatment with osmoactive agents such as mannitol or hypertonic saline (HTS) solutions is widely used to manage or prevent the increase of intracranial pressure (ICP) in central nervous system (CNS) disorders. We sought to evaluate the variability and mean plasma concentrations of the water and electrolyte balance parameters in critically ill patients treated with osmotic therapy and their influence on mortality. This cohort study covered patients hospitalized in an intensive care unit (ICU) from January 2017 to June 2019 with presumed increased ICP or considered to be at risk of it, treated with 15% mannitol (G1, n = 27), a combination of 15% mannitol and 10% hypertonic saline (HTS) (G2, n = 33) or 10% HTS only (G3, n = 13). Coefficients of variation (Cv) and arithmetic means (mean) were calculated for the parameters reflecting the water and electrolyte balance, i.e., sodium (NaCv/NaMean), chloride (ClCv/ClMean) and osmolality (mOsmCv/mOsmMean). In-hospital mortality was also analyzed. The study group comprised 73 individuals (36 men, 49%). Mortality was 67% (n = 49). Median NaCv (G1: = 0.002, G3: = 0.03), ClCv (G1: = 0.02, G3: = 0.04) and mOsmCv (G1: = 0.001, G3: = 0.02) were higher in deceased patients. NaMean ( = 0.004), ClMean ( = 0.04), mOsmMean ( = 0.003) were higher in deceased patients in G3. In G1: NaCv (AUC = 0.929, < 0.0001), ClCv (AUC = 0.817, = 0.0005), mOsmCv (AUC = 0.937, < 0.0001) and in G3: NaMean (AUC = 0.976, < 0.001), mOsmCv (AUC = 0.881, = 0.002), mOsmMean (AUC = 1.00, < 0.001) were the best predictors of mortality. The overall mortality prediction for combined G1+G2+G3 was very good, with AUC = 0.886 ( = 0.0002). The mortality of critically ill patients treated with osmotic agents is high. Electrolyte disequilibrium is the independent predictor of mortality regardless of the treatment method used. Variations of plasma sodium, chloride and osmolality are the most deleterious factors regardless of the absolute values of these parameters.
Download full-text PDF |
Source |
---|---|
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345768 | PMC |
http://dx.doi.org/10.3390/ijerph17124573 | DOI Listing |
J Neurosurg Case Lessons
December 2024
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Background: Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a rare central nervous system tumor, especially in adult females. Typically, it presents with leptomeningeal enhancements in the basal cisterns and spinal cord. However, varied radiological and pathological features can complicate the diagnosis, as the present case illustrates.
View Article and Find Full Text PDFFront Oncol
December 2024
Department of Neurosurgery, Zibo Central Hospital, Zibo, China.
Meningiomas are some of the most prevalent primary brain tumors in adults, and are typically non-neuroglial in nature. A variety of symptoms may be observed, including headaches, fluctuations in mental status, ataxia, muscle weakness, nausea and vomiting, seizures, visual changes, speech disorders, and sensory abnormalities. The World Health Organization (WHO) has a grading system for meningiomas based on histological criteria, which is as follows: Grade 1 meningiomas are considered benign; Grade 2 meningiomas have a moderately aggressive nature and usually present with histological atypia; and Grade 3 meningiomas exhibit aggressive malignant behavior.
View Article and Find Full Text PDFBest Pract Res Clin Gastroenterol
December 2024
Institute of Digestive & Liver Diseases, BLK Superspeciality Hospital, Delhi, India. Electronic address:
Neurological complications in acute liver failure are the most common cause of mortality in this group of patients. Almost all neurologic complications arise from underlying increase in intracranial pressure in ALF. In addition to symptomatic management, the treatment relies on measures to bring down ICP.
View Article and Find Full Text PDFRev Esp Anestesiol Reanim (Engl Ed)
December 2024
Department of Anaesthesiology, Hospital Beatriz Ângelo, Loures, Portugal.
Pneumocephalus refers to the presence of air within the intracranial cavity, and albeit its occurrence following neuraxial techniques is rare, it is commonly associated with a loss of resistance to air technique. This case report describes a parturient who underwent neuraxial analgesia for pain management during labour. Epidural space identification with loss of resistance to saline technique was used and she went on to develop a symptomatic pneumocephalus.
View Article and Find Full Text PDFCrit Care
December 2024
Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Background: Intracranial multimodal monitoring (iMMM) is increasingly used in neurocritical care, but a lack of standardization hinders its evidence-based development. Here, we devised core outcome sets (COS) and reporting guidelines to harmonize iMMM practices and research.
Methods: An open, decentralized, three-round Delphi consensus study involved experts between December 2023 and June 2024.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!