Tuesday, February 11, 2020


PulmCrit Wee - February 11, 2020 by Josh Farkas 
Ref: Griffin M, Soufer A, Goljo E, et al. Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure. JACC: Heart Failure. February 2020. doi:10.1016/j.jchf.2019.10.012

..."Summary The Bullet: 
  • Hyperdiuresis involves a combination of hypertonic saline and loop diuretic, for management of refractory volume overload.
  • This retrospective cohort study describes 58 episodes of hyperdiuresis among a cohort of profoundly ill patients with decompensated heart failure and diuretic resistance (most of whom had severely impaired cardiac and renal function).
  • Hyperdiuresis was successful in achieving volume removal, with a simultaneous improvement in renal function. 
  • Hyperdiuresis was well tolerated. There was no signal of increasing pulmonary edema. Hyperdiuresis did tend to increase the sodium and chloride levels, but these shifts were moderate (and tended to push patients towards normal values). 
  • Further investigation of hyperdiuresis is needed (ideally in the form of a RCT). In the interim, this seems to be a very reasonable treatment consideration for patients who are refractory to other therapies."
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