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
Hauptverfasser: 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
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container_issue 3
container_start_page 380
container_title The American surgeon
container_volume 88
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
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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 &lt; .0001), as were ICP and serum osmolality at 6-72 hours after presentation (R2 .116, P &lt; .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. 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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 &lt; .0001), as were ICP and serum osmolality at 6-72 hours after presentation (R2 .116, P &lt; .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. 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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 &lt; .0001), as were ICP and serum osmolality at 6-72 hours after presentation (R2 .116, P &lt; .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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