Hypernatremia or Hyperosmolarity fails to protect critically ill patients from lung injury

USA: The results of a study published in the Journal of Critical Care have concluded that manipulating serum sodium/osmolarity is not a lung-protective measure at the early stage of critical illness.

The study investigated the potential association between sodium/osmolarity levels (admission) and Acute Respiratory Distress Syndrome during ICU admission.

The previously published studies have emphasized that hypernatremia or Hyperosmolarity may be related to protective effects in lung injury. The data remains unproven in a large-scale clinical setting.

Considering this, a team of researchers led by Dr Li from the Department of Medicine in the Division of Pulmonary and Critical Care Medicine at Mayo Clinic hypothesized that hypernatremia and/or Hyperosmolarity would have a role in preventing ARDS.

The key points of the study are:

• The study got approval from Mayo Clinic Institutional Review Board.

• The study Title was: Does Serum Osmolarity Affect Outcomes of acute lung injury Patients?

• The type of study was a retrospective cohort study.

• The age of included adult patients was≥ 18 years old.

• Only the first ICU admission was included in the study in case of more than one ICU admission during one hospitalization.

• A valid computerized search study was applied to identify the occurrence of ARDS.

• The multivariable logistic regression model analyzed the association between serum sodium/osmolarity and ARDS outcomes.

• Linear and logistic regression models analyzed the relation between serum sodium/osmolarity and ARDS outcomes.

• Fifty thousand four hundred ninety-eight patients were analyzed.

• There was no significant association between the serum sodium level on admission and ARDS occurrence, with an adjusted OR of 0.95.

• Between calculated serum osmolarity and ARDS occurrence, there was no significant association. The adjusted OR was 1.03.

• During ICU stay, 1560 patients developed ARDS.

• There was no significant association between serum sodium level and osmolarity levels and outcomes.

The conclusion by the researchers was mentioned as, " In ICU, there is no association between admission serum sodium or serum osmolarity and ARDS occurrence or outcomes."

They said, "Our study has the strength of the first large clinical cohort study investigating the association between hypernatremia/hyperosmolarity and ARDS in the era of Berlin definition."

We tried to answer a question:

In the critically ill population, does hypernatremia or Hyperosmolarity have a lung-protective effect?

We discovered that admission serum sodium or serum osmolarity is not associated with ARDS occurrence and outcomes in critically ill patients at risk of lung injury.

Further reading:

Admission serum sodium and osmolarity are not associated with the occurrence or outcomes of acute respiratory distress syndrome in critically ill. Li et al.