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Plasma Hyperosmolality Prolongs QTc Interval and Increases Risk for Atrial Fibrillation in Traumatic Brain Injury Patients

Introduction: Hyperosmotic therapy with mannitol is frequently used for treatment cerebral edema, and 320 mOsm/kg H(2)O has been recommended as a high limit for therapeutic plasma osmolality. However, plasma hyperosmolality may impair cardiac function, increasing the risk of cardiac events. The aim...

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Autores principales: Dabrowski, Wojciech, Siwicka-Gieroba, Dorota, Robba, Chiara, Badenes, Rafael, Bialy, Mateusz, Iwaniuk, Paulina, Schlegel, Todd T, Jaroszynski, Andrzej
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288326/
https://www.ncbi.nlm.nih.gov/pubmed/32365845
http://dx.doi.org/10.3390/jcm9051293
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author Dabrowski, Wojciech
Siwicka-Gieroba, Dorota
Robba, Chiara
Badenes, Rafael
Bialy, Mateusz
Iwaniuk, Paulina
Schlegel, Todd T
Jaroszynski, Andrzej
author_facet Dabrowski, Wojciech
Siwicka-Gieroba, Dorota
Robba, Chiara
Badenes, Rafael
Bialy, Mateusz
Iwaniuk, Paulina
Schlegel, Todd T
Jaroszynski, Andrzej
author_sort Dabrowski, Wojciech
collection PubMed
description Introduction: Hyperosmotic therapy with mannitol is frequently used for treatment cerebral edema, and 320 mOsm/kg H(2)O has been recommended as a high limit for therapeutic plasma osmolality. However, plasma hyperosmolality may impair cardiac function, increasing the risk of cardiac events. The aim of this study was to analyze the relation between changes in plasma osmolality and electrocardiographic variables and cardiac arrhythmia in patients treated for isolated traumatic brain injury (iTBI). Methods: Adult iTBI patients requiring mannitol infusion following cerebral edema, and with a Glasgow Coma Score below 8, were included. Plasma osmolality was measured with Osmometr 800 CLG. Spatial QRS-T angle (spQRS-T), corrected QT interval (QTc) and STJ segment were calculated from digital resting 12-lead ECGs and analyzed in relation to four levels of plasma osmolality: (A) <280 mOsm/kg H(2)O; (B) 280–295 mOsm/kg H(2)O; (C) 295–310 mOsm/kg H(2)O; and (D) >310 mOsm/kg H(2)O. All parameters were measured during five consecutive days of treatment. Results: 94 patients aged 18-64 were studied. Increased plasma osmolality correlated with prolonged QTc (p < 0.001), intensified disorders in STJ and increased the risk for cardiac arrhythmia. Moreover, plasma osmolality >313 mOms/kg H(2)O significantly increased the risk of QTc prolongation >500 ms. Conclusion: In patients treated for iTBI, excessively increased plasma osmolality contributes to electrocardiographic disorders including prolonged QTc, while also correlating with increased risk for cardiac arrhythmias.
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spelling pubmed-72883262020-06-17 Plasma Hyperosmolality Prolongs QTc Interval and Increases Risk for Atrial Fibrillation in Traumatic Brain Injury Patients Dabrowski, Wojciech Siwicka-Gieroba, Dorota Robba, Chiara Badenes, Rafael Bialy, Mateusz Iwaniuk, Paulina Schlegel, Todd T Jaroszynski, Andrzej J Clin Med Article Introduction: Hyperosmotic therapy with mannitol is frequently used for treatment cerebral edema, and 320 mOsm/kg H(2)O has been recommended as a high limit for therapeutic plasma osmolality. However, plasma hyperosmolality may impair cardiac function, increasing the risk of cardiac events. The aim of this study was to analyze the relation between changes in plasma osmolality and electrocardiographic variables and cardiac arrhythmia in patients treated for isolated traumatic brain injury (iTBI). Methods: Adult iTBI patients requiring mannitol infusion following cerebral edema, and with a Glasgow Coma Score below 8, were included. Plasma osmolality was measured with Osmometr 800 CLG. Spatial QRS-T angle (spQRS-T), corrected QT interval (QTc) and STJ segment were calculated from digital resting 12-lead ECGs and analyzed in relation to four levels of plasma osmolality: (A) <280 mOsm/kg H(2)O; (B) 280–295 mOsm/kg H(2)O; (C) 295–310 mOsm/kg H(2)O; and (D) >310 mOsm/kg H(2)O. All parameters were measured during five consecutive days of treatment. Results: 94 patients aged 18-64 were studied. Increased plasma osmolality correlated with prolonged QTc (p < 0.001), intensified disorders in STJ and increased the risk for cardiac arrhythmia. Moreover, plasma osmolality >313 mOms/kg H(2)O significantly increased the risk of QTc prolongation >500 ms. Conclusion: In patients treated for iTBI, excessively increased plasma osmolality contributes to electrocardiographic disorders including prolonged QTc, while also correlating with increased risk for cardiac arrhythmias. MDPI 2020-04-30 /pmc/articles/PMC7288326/ /pubmed/32365845 http://dx.doi.org/10.3390/jcm9051293 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Dabrowski, Wojciech
Siwicka-Gieroba, Dorota
Robba, Chiara
Badenes, Rafael
Bialy, Mateusz
Iwaniuk, Paulina
Schlegel, Todd T
Jaroszynski, Andrzej
Plasma Hyperosmolality Prolongs QTc Interval and Increases Risk for Atrial Fibrillation in Traumatic Brain Injury Patients
title Plasma Hyperosmolality Prolongs QTc Interval and Increases Risk for Atrial Fibrillation in Traumatic Brain Injury Patients
title_full Plasma Hyperosmolality Prolongs QTc Interval and Increases Risk for Atrial Fibrillation in Traumatic Brain Injury Patients
title_fullStr Plasma Hyperosmolality Prolongs QTc Interval and Increases Risk for Atrial Fibrillation in Traumatic Brain Injury Patients
title_full_unstemmed Plasma Hyperosmolality Prolongs QTc Interval and Increases Risk for Atrial Fibrillation in Traumatic Brain Injury Patients
title_short Plasma Hyperosmolality Prolongs QTc Interval and Increases Risk for Atrial Fibrillation in Traumatic Brain Injury Patients
title_sort plasma hyperosmolality prolongs qtc interval and increases risk for atrial fibrillation in traumatic brain injury patients
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288326/
https://www.ncbi.nlm.nih.gov/pubmed/32365845
http://dx.doi.org/10.3390/jcm9051293
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