The Relationship between Serum Sodium, Serum Osmolality, and Intracranial Pressure in Patients with Traumatic Brain Injury Treated with Hyperosmolar Therapy
Background Treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI) is controversial. Hyperosmolar therapy is used to prevent cerebral edema in these patients. Many intensivists measure direct correlates of these agents—serum sodium and osmolality. We seek to provide context...
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Veröffentlicht in: | The American surgeon 2022-03, Vol.88 (3), p.380-383 |
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creator | Farley, Paige Salisbury, Daniel Murfee, John R Buckley, Colin T Taylor, Catherine N Doll, Alissa Polite, Nathan M Mbaka, Maryann I Kinnard, Christopher M Butts, Charles Caleb Simmons, Jon D Lee, Yann‐Leei L |
description | Background
Treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI) is controversial. Hyperosmolar therapy is used to prevent cerebral edema in these patients. Many intensivists measure direct correlates of these agents—serum sodium and osmolality. We seek to provide context on the utility of using these measures to estimate ICP in TBI patients.
Materials and Methods
Patients admitted with TBI who required ICP monitoring from 2008 to 2012 were included. Intracranial pressure, serum sodium, and serum osmolality were assessed prior to hyperosmotic therapy then at 6, 12, 18, 24, 48, and 72 hours after admission. A linear regression was performed on sodium, osmolality, and ICP at baseline and serum sodium and osmolality that corresponded with ICP for 6-72-hour time points.
Results
136 patients were identified. Patients with initial measures were included in the baseline analysis (n = 29). Patients who underwent a craniectomy were excluded from the 6-72-hour analysis (n = 53). Initial ICP and serum sodium were not significantly correlated (R2 .00367, P = .696). Initial ICP and serum osmolality were not significantly correlated (R2 .00734, P = .665). Intracranial pressure and serum sodium 6-72 hours after presentation were poorly correlated (R2 .104, P < .0001), as were ICP and serum osmolality at 6-72 hours after presentation (R2 .116, P < .0001).
Discussion
Our results indicate initial ICP is not correlated with serum sodium or osmolality suggesting these are not useful initial clinical markers for ICP estimation. The association between ICP and serum sodium and osmolality after hyperosmolar therapy was poor, thus may not be useful as surrogates for direct ICP measurements. |
doi_str_mv | 10.1177/00031348211058627 |
format | Article |
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Treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI) is controversial. Hyperosmolar therapy is used to prevent cerebral edema in these patients. Many intensivists measure direct correlates of these agents—serum sodium and osmolality. We seek to provide context on the utility of using these measures to estimate ICP in TBI patients.
Materials and Methods
Patients admitted with TBI who required ICP monitoring from 2008 to 2012 were included. Intracranial pressure, serum sodium, and serum osmolality were assessed prior to hyperosmotic therapy then at 6, 12, 18, 24, 48, and 72 hours after admission. A linear regression was performed on sodium, osmolality, and ICP at baseline and serum sodium and osmolality that corresponded with ICP for 6-72-hour time points.
Results
136 patients were identified. Patients with initial measures were included in the baseline analysis (n = 29). Patients who underwent a craniectomy were excluded from the 6-72-hour analysis (n = 53). Initial ICP and serum sodium were not significantly correlated (R2 .00367, P = .696). Initial ICP and serum osmolality were not significantly correlated (R2 .00734, P = .665). Intracranial pressure and serum sodium 6-72 hours after presentation were poorly correlated (R2 .104, P < .0001), as were ICP and serum osmolality at 6-72 hours after presentation (R2 .116, P < .0001).
Discussion
Our results indicate initial ICP is not correlated with serum sodium or osmolality suggesting these are not useful initial clinical markers for ICP estimation. The association between ICP and serum sodium and osmolality after hyperosmolar therapy was poor, thus may not be useful as surrogates for direct ICP measurements.</description><identifier>ISSN: 0003-1348</identifier><identifier>EISSN: 1555-9823</identifier><identifier>DOI: 10.1177/00031348211058627</identifier><identifier>PMID: 34969299</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Adult ; Biomarkers - blood ; Brain ; Brain Injuries, Traumatic - blood ; Brain Injuries, Traumatic - complications ; Brain Injuries, Traumatic - physiopathology ; Brain research ; Drug dosages ; Edema ; Electrolytes ; Head injuries ; Humans ; Injury prevention ; Injury Severity Score ; Intracranial Hypertension - blood ; Intracranial Hypertension - diagnosis ; Intracranial Hypertension - etiology ; Intracranial Hypertension - therapy ; Intracranial Pressure ; Linear Models ; Osmolar Concentration ; Osmotic pressure ; Patients ; Pressure ; Regression analysis ; Retrospective Studies ; Sodium ; Sodium - blood ; Therapy ; Time Factors ; Trauma ; Traumatic brain injury</subject><ispartof>The American surgeon, 2022-03, Vol.88 (3), p.380-383</ispartof><rights>The Author(s) 2021</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-bc76c48c0abedb88c70b40c62f26537486aca2bc7abe1a69ecea64c584d221ff3</citedby><cites>FETCH-LOGICAL-c368t-bc76c48c0abedb88c70b40c62f26537486aca2bc7abe1a69ecea64c584d221ff3</cites><orcidid>0000-0002-5766-601X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/00031348211058627$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/00031348211058627$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34969299$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Farley, Paige</creatorcontrib><creatorcontrib>Salisbury, Daniel</creatorcontrib><creatorcontrib>Murfee, John R</creatorcontrib><creatorcontrib>Buckley, Colin T</creatorcontrib><creatorcontrib>Taylor, Catherine N</creatorcontrib><creatorcontrib>Doll, Alissa</creatorcontrib><creatorcontrib>Polite, Nathan M</creatorcontrib><creatorcontrib>Mbaka, Maryann I</creatorcontrib><creatorcontrib>Kinnard, Christopher M</creatorcontrib><creatorcontrib>Butts, Charles Caleb</creatorcontrib><creatorcontrib>Simmons, Jon D</creatorcontrib><creatorcontrib>Lee, Yann‐Leei L</creatorcontrib><title>The Relationship between Serum Sodium, Serum Osmolality, and Intracranial Pressure in Patients with Traumatic Brain Injury Treated with Hyperosmolar Therapy</title><title>The American surgeon</title><addtitle>Am Surg</addtitle><description>Background
Treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI) is controversial. Hyperosmolar therapy is used to prevent cerebral edema in these patients. Many intensivists measure direct correlates of these agents—serum sodium and osmolality. We seek to provide context on the utility of using these measures to estimate ICP in TBI patients.
Materials and Methods
Patients admitted with TBI who required ICP monitoring from 2008 to 2012 were included. Intracranial pressure, serum sodium, and serum osmolality were assessed prior to hyperosmotic therapy then at 6, 12, 18, 24, 48, and 72 hours after admission. A linear regression was performed on sodium, osmolality, and ICP at baseline and serum sodium and osmolality that corresponded with ICP for 6-72-hour time points.
Results
136 patients were identified. Patients with initial measures were included in the baseline analysis (n = 29). Patients who underwent a craniectomy were excluded from the 6-72-hour analysis (n = 53). Initial ICP and serum sodium were not significantly correlated (R2 .00367, P = .696). Initial ICP and serum osmolality were not significantly correlated (R2 .00734, P = .665). Intracranial pressure and serum sodium 6-72 hours after presentation were poorly correlated (R2 .104, P < .0001), as were ICP and serum osmolality at 6-72 hours after presentation (R2 .116, P < .0001).
Discussion
Our results indicate initial ICP is not correlated with serum sodium or osmolality suggesting these are not useful initial clinical markers for ICP estimation. The association between ICP and serum sodium and osmolality after hyperosmolar therapy was poor, thus may not be useful as surrogates for direct ICP measurements.</description><subject>Adult</subject><subject>Biomarkers - blood</subject><subject>Brain</subject><subject>Brain Injuries, Traumatic - blood</subject><subject>Brain Injuries, Traumatic - complications</subject><subject>Brain Injuries, Traumatic - physiopathology</subject><subject>Brain research</subject><subject>Drug dosages</subject><subject>Edema</subject><subject>Electrolytes</subject><subject>Head injuries</subject><subject>Humans</subject><subject>Injury prevention</subject><subject>Injury Severity Score</subject><subject>Intracranial Hypertension - blood</subject><subject>Intracranial Hypertension - diagnosis</subject><subject>Intracranial Hypertension - etiology</subject><subject>Intracranial Hypertension - therapy</subject><subject>Intracranial Pressure</subject><subject>Linear Models</subject><subject>Osmolar Concentration</subject><subject>Osmotic pressure</subject><subject>Patients</subject><subject>Pressure</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Sodium</subject><subject>Sodium - blood</subject><subject>Therapy</subject><subject>Time Factors</subject><subject>Trauma</subject><subject>Traumatic brain injury</subject><issn>0003-1348</issn><issn>1555-9823</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFu1DAQhi0EosvCA3BBlrhwaIrtOI5zhAralSq1oss5mjgT1qvECbajKu_Cw-JllyKBOFkz_ze_x_4Jec3ZBedl-Z4xlvNcasE5K7QS5ROy4kVRZJUW-VOyOujZATgjL0LYp1Kqgj8nZ7msVCWqakV-bHdIv2AP0Y4u7OxEG4wPiI7eo58Hej-2dh7OT9VtGMYeehuXcwqupRsXPRgPzkJP7zyGMHuk1tG75IcuBvpg445uPcxD6hj60UNSN24_-yW1ESK2R-Z6mdCPv_w9TUt5mJaX5FkHfcBXp3NNvn7-tL28zm5urzaXH24ykysds8aUykhtGDTYNlqbkjWSGSU6oYq8lFqBAZGopHNQFRoEJU2hZSsE77p8Td4dfSc_fp8xxHqwwWDfg8NxDrVQvKgEY8ltTd7-he7H2bu0XaJyJjVT6e_XhB8pk54UPHb15O0Afqk5qw_R1f9El2benJznZsD2ceJ3Vgm4OAIBvuGfa__v-BOGaqO7</recordid><startdate>20220301</startdate><enddate>20220301</enddate><creator>Farley, Paige</creator><creator>Salisbury, Daniel</creator><creator>Murfee, John R</creator><creator>Buckley, Colin T</creator><creator>Taylor, Catherine N</creator><creator>Doll, Alissa</creator><creator>Polite, Nathan M</creator><creator>Mbaka, Maryann I</creator><creator>Kinnard, Christopher M</creator><creator>Butts, Charles Caleb</creator><creator>Simmons, Jon D</creator><creator>Lee, Yann‐Leei L</creator><general>SAGE Publications</general><general>SAGE PUBLICATIONS, INC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>4T-</scope><scope>4U-</scope><scope>7QL</scope><scope>7T7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5766-601X</orcidid></search><sort><creationdate>20220301</creationdate><title>The Relationship between Serum Sodium, Serum Osmolality, and Intracranial Pressure in Patients with Traumatic Brain Injury Treated with Hyperosmolar Therapy</title><author>Farley, Paige ; Salisbury, Daniel ; Murfee, John R ; Buckley, Colin T ; Taylor, Catherine N ; Doll, Alissa ; Polite, Nathan M ; Mbaka, Maryann I ; Kinnard, Christopher M ; Butts, Charles Caleb ; Simmons, Jon D ; Lee, Yann‐Leei L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-bc76c48c0abedb88c70b40c62f26537486aca2bc7abe1a69ecea64c584d221ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adult</topic><topic>Biomarkers - blood</topic><topic>Brain</topic><topic>Brain Injuries, Traumatic - blood</topic><topic>Brain Injuries, Traumatic - complications</topic><topic>Brain Injuries, Traumatic - physiopathology</topic><topic>Brain research</topic><topic>Drug dosages</topic><topic>Edema</topic><topic>Electrolytes</topic><topic>Head injuries</topic><topic>Humans</topic><topic>Injury prevention</topic><topic>Injury Severity Score</topic><topic>Intracranial Hypertension - blood</topic><topic>Intracranial Hypertension - diagnosis</topic><topic>Intracranial Hypertension - etiology</topic><topic>Intracranial Hypertension - therapy</topic><topic>Intracranial Pressure</topic><topic>Linear Models</topic><topic>Osmolar Concentration</topic><topic>Osmotic pressure</topic><topic>Patients</topic><topic>Pressure</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Sodium</topic><topic>Sodium - blood</topic><topic>Therapy</topic><topic>Time Factors</topic><topic>Trauma</topic><topic>Traumatic brain injury</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Farley, Paige</creatorcontrib><creatorcontrib>Salisbury, Daniel</creatorcontrib><creatorcontrib>Murfee, John R</creatorcontrib><creatorcontrib>Buckley, Colin T</creatorcontrib><creatorcontrib>Taylor, Catherine N</creatorcontrib><creatorcontrib>Doll, Alissa</creatorcontrib><creatorcontrib>Polite, Nathan M</creatorcontrib><creatorcontrib>Mbaka, Maryann I</creatorcontrib><creatorcontrib>Kinnard, Christopher M</creatorcontrib><creatorcontrib>Butts, Charles Caleb</creatorcontrib><creatorcontrib>Simmons, Jon D</creatorcontrib><creatorcontrib>Lee, Yann‐Leei L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American surgeon</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Farley, Paige</au><au>Salisbury, Daniel</au><au>Murfee, John R</au><au>Buckley, Colin T</au><au>Taylor, Catherine N</au><au>Doll, Alissa</au><au>Polite, Nathan M</au><au>Mbaka, Maryann I</au><au>Kinnard, Christopher M</au><au>Butts, Charles Caleb</au><au>Simmons, Jon D</au><au>Lee, Yann‐Leei L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Relationship between Serum Sodium, Serum Osmolality, and Intracranial Pressure in Patients with Traumatic Brain Injury Treated with Hyperosmolar Therapy</atitle><jtitle>The American surgeon</jtitle><addtitle>Am Surg</addtitle><date>2022-03-01</date><risdate>2022</risdate><volume>88</volume><issue>3</issue><spage>380</spage><epage>383</epage><pages>380-383</pages><issn>0003-1348</issn><eissn>1555-9823</eissn><abstract>Background
Treatment of elevated intracranial pressure (ICP) in traumatic brain injury (TBI) is controversial. Hyperosmolar therapy is used to prevent cerebral edema in these patients. Many intensivists measure direct correlates of these agents—serum sodium and osmolality. We seek to provide context on the utility of using these measures to estimate ICP in TBI patients.
Materials and Methods
Patients admitted with TBI who required ICP monitoring from 2008 to 2012 were included. Intracranial pressure, serum sodium, and serum osmolality were assessed prior to hyperosmotic therapy then at 6, 12, 18, 24, 48, and 72 hours after admission. A linear regression was performed on sodium, osmolality, and ICP at baseline and serum sodium and osmolality that corresponded with ICP for 6-72-hour time points.
Results
136 patients were identified. Patients with initial measures were included in the baseline analysis (n = 29). Patients who underwent a craniectomy were excluded from the 6-72-hour analysis (n = 53). Initial ICP and serum sodium were not significantly correlated (R2 .00367, P = .696). Initial ICP and serum osmolality were not significantly correlated (R2 .00734, P = .665). Intracranial pressure and serum sodium 6-72 hours after presentation were poorly correlated (R2 .104, P < .0001), as were ICP and serum osmolality at 6-72 hours after presentation (R2 .116, P < .0001).
Discussion
Our results indicate initial ICP is not correlated with serum sodium or osmolality suggesting these are not useful initial clinical markers for ICP estimation. The association between ICP and serum sodium and osmolality after hyperosmolar therapy was poor, thus may not be useful as surrogates for direct ICP measurements.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>34969299</pmid><doi>10.1177/00031348211058627</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0002-5766-601X</orcidid></addata></record> |
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subjects | Adult Biomarkers - blood Brain Brain Injuries, Traumatic - blood Brain Injuries, Traumatic - complications Brain Injuries, Traumatic - physiopathology Brain research Drug dosages Edema Electrolytes Head injuries Humans Injury prevention Injury Severity Score Intracranial Hypertension - blood Intracranial Hypertension - diagnosis Intracranial Hypertension - etiology Intracranial Hypertension - therapy Intracranial Pressure Linear Models Osmolar Concentration Osmotic pressure Patients Pressure Regression analysis Retrospective Studies Sodium Sodium - blood Therapy Time Factors Trauma Traumatic brain injury |
title | The Relationship between Serum Sodium, Serum Osmolality, and Intracranial Pressure in Patients with Traumatic Brain Injury Treated with Hyperosmolar Therapy |
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