Introduction: Desmopressin improves hemostasis through the release of factor VIII, von Willebrand factor, and tissue plasminogen activator, and increases platelet adhesion. Neurocritical Care guidelines recommend consideration of desmopressin in antiplatelet-associated intracranial hemorrhage. Studies supporting its use have not evaluated the potential impact of desmopressin on serum sodium levels in patients receiving hypertonic saline therapy. The purpose of this study was to assess the impact of desmopressin on sodium levels and hypertonic saline effectiveness in intracranial hemorrhage.
Methods: This was a single center retrospective observational chart review. Patients were included in the desmopressin group if they were diagnosed with intracranial hemorrhage, administered desmopressin, and received hypertonic saline infusion. Patients in the hypertonic saline alone group were then matched 1:1 to the patients in the desmopressin group. The primary end point was the effect of desmopressin on reaching a sodium goal of 145-155 mEq/L. The secondary end points included intensive care unit and hospital length of stay, change in sodium, time to reach sodium goal, thrombotic events, mortality, and a composite of increased cerebral edema, hematoma expansion, midline shift, herniation, need for neurosurgical intervention, and neurologic decompensation.
Results: Of 112 patients screened, 25 patients met inclusion criteria for the desmopressin group, and 25 patients were matched with patients in the hypertonic saline alone group. The percentage of patients who reached goal sodium in the desmopressin group compared with hypertonic saline alone was similar (80% vs. 88%, respectively). There were no differences in the secondary end points. In the subgroup analysis, patients in the hypertonic saline group met the predefined sodium goal of 150-155 mEq/L within 48 h more often than those in the desmopressin group (82% vs. 60%, respectively, p = 0.042).
Conclusions: The use of desmopressin in intracranial hemorrhage does not appear to negatively impact the ability for patients to reach goal sodium of 145-155 mEq/L. However, in patients with higher sodium goals, desmopressin may decrease hypertonic saline effectiveness.
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http://dx.doi.org/10.1007/s12028-021-01277-2 | DOI Listing |
Objective: To determine whether a standardized perioperative protocol for patients undergoing brachycephalic obstructive airway syndrome (BOAS) surgery reduces the incidence of regurgitation, aspiration pneumonia, and respiratory distress in the postoperative period.
Methods: The records of client-owned dogs referred to the Texas A&M University Small Animal Teaching Hospital for surgical correction of BOAS over 4 years (February 2019 to June 2023) were retrospectively reviewed. A perioperative protocol for patients undergoing surgical correction of BOAS was implemented in June 2021, which included preoperative cisapride and antacid administration, minimizing opioid use, and a slow recovery with nebulization of hypertonic saline.
The 2024 European Society of Intensive Care Medicine clinical practice guideline provide clinicians with evidence-based recommendations on intravenous fluid in critically ill adults across a range of common conditions. These guidelines aim to improve the practices of fluid therapy by adopting a global perspective that considers both clinical efficacy and resource utilization in diverse healthcare settings. The guidelines address three key questions: (1) albumin versus crystalloids, (2) balanced crystalloids versus isotonic saline, and (3) small-volume hypertonic solutions versus isotonic crystalloids.
View Article and Find Full Text PDFJ Community Hosp Intern Med Perspect
January 2025
Critical Care Medicine, Freeman Health System, Joplin, MO, USA.
Acute urine retention is a common urologic emergency that is frequently seen in the Emergency room (ER). Standard treatment includes placing a urinary catheter or a suprapubic catheter with outpatient urologic follow-up. Urine retention can cause complications, such as hyponatremia and post-obstructive diuresis.
View Article and Find Full Text PDFIntroduction: Elexacaftor/tezacaftor/ivacaftor (ETI) has shown significant improvements in pulmonary and nutritional status in persons with cystic fibrosis (pwCF). Less is known about the extrapulmonary impact of ETI and effects on airway microbiology, lung clearance index (LCI) and fraction of exhaled nitric oxide (FeNO).
Methods: A multicentre prospective observational trial, including 79 pwCF ≥ 18 years eligible for ETI.
Int J Surg Case Rep
January 2025
Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka. Electronic address:
Introduction: Necrotizing fasciitis (NF) is a rapidly progressive life-threatening infection involving necrosis of subcutaneous tissues and fascia. Though it mainly affects the extremities, perineum and abdominal wall, it rarely affects the breast.
Presentation Of Case: A 30-year-old woman on postpartum day seven presented with one-day history of fever with chills and rigors and painful, swollen and tender left breast.
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