Residents and Fellows Research in Progress
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction: Adult patients with various neurologic injuries in the intensive care unit (ICU) often require hyperosmolar therapy to prevent or manage elevated intracranial pressure (ICP) and cerebral edema to help mitigate serious complications. Hypertonic saline (HTS) in concentrations ranging from 3% to 23.4% sodium chloride (NaCl) is preferred over mannitol due to better efficacy and fewer side effects; however, there is still debate in the literature regarding optimal administration. Common strategies utilize bolus dosing of 3% to 23.4% NaCl and/or continuous infusions of 3% to 7% NaCl. HTS is a high-risk medication requiring careful monitoring and administration to prevent patient harm. This IRB exempt quality improvement project aims to create a standardized HTS bolus and infusion policy for use in the adult ICU to manage patients with or at risk for elevated ICP and cerebral edema.
Research Question or Hypothesis: Does implementation of a standardized HTS policy improve time to goal sodium range?
Study Design: Single-center, retrospective, quality improvement project
Methods: Patients = 18 years old admitted to the ICU with or at risk of elevated ICP who have HTS ordered for ICP management will be eligible for inclusion. A goal sodium range will be selected by the ordering provider. A baseline serum sodium will be obtained and then monitored every 4 hours during HTS therapy. The pre-intervention study period will be June 1 through September 30, 2023 and the post-intervention period will be December 1, 2023 through March 31, 2024. The primary outcomes are time to goal sodium range and time in goal sodium range. Secondary outcomes include time to first dose of HTS, time with CPP > 60 mmHg and reduction in ICP.
Results: This research is currently in progress. Results are pending.
Conclusion: Conclusions will be available pending completion of this study.
Presenting Author
Sofia Manczurowsky Pharm.D.Eastern Idaho Regional Medical Center
Authors
Erin Berry PharmD, BCPS
Eastern Idaho Regional Medical Center
Eliza Borzadek BSN, PharmD, BCPS
Eastern Idaho Regional Medical Center
Rachel Lopez PharmD, BCPS
Eastern Idaho Regional Medical Center
Lindsey Reeder Pharm.D., BCCCP
Eastern Idaho Regional Medical Center