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INTRODUCTION: Hyponatremia, frequently encountered in intensive care (ICU) settings, plays a critical role in shaping patient outcomes. Despite its prevalence, contemporary research into its newly classified severity categories and their implications on mortality, renal function, and length of stay remains limited. This study aims to fill this gap by examining the impact of hyponatremia severity on these critical outcomes. METHODS: A retrospective analysis of ICU patients aged >18 years who were admitted between March 2019 and December 2022 was conducted at Hamamatsu University Hospital, Shizuoka, Japan. Patients who were readmitted or had incomplete data were excluded. Hyponatremia was categorized as mild (130-135 mmol/L), moderate (125-129 mmol/L), or severe (<125 mmol/L), following the criteria set by the European Society of Intensive Care Medicine. This classification utilized the lowest sodium concentration within 24 hours of ICU admission. The outcomes were in-hospital mortality, ICU mortality, newly implemented renal replacement therapy (RRT), and length of hospital and ICU stay. Outcomes were analyzed using multivariable logistic and linear regression models, adjusting for relevant covariates including age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) III scores, and the use of mechanical ventilation. RESULTS: Of the 3,538 patients analyzed, 1,072 (30.3%) experienced hyponatremia: 894 (25.3%) mild, 144 (4.1%) moderate, and 34 (1.0%) severe. Multivariable analysis revealed no significant association between hyponatremia severity and in-hospital mortality rates across normonatremia (3.8%), mild (5.2%), moderate (11.8%), and severe (23.5%) groups, nor with ICU mortality. However, compared to normonatremia, moderate and severe hyponatremia were associated with increased RRT initiation (odds ratios = 3.83 and 6.36, respectively) and prolonged hospital stay (mean difference = 7.06 and 9.66 days, respectively), and ICU stays (mean difference, 1.02 and 2.70 days, respectively). Mild hyponatremia was not significantly associated with RRT or length of stay. CONCLUSION: Moderate-to-severe hyponatremia did not influence mortality but was associated with increased RRT initiation and prolonged hospital and ICU stay. By contrast, mild hyponatremia was not associated with any clinical outcome. Further research is required to determine if correcting hyponatremia directly improves ICU patient outcomes, given the observational nature of the study.
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BACKGROUND: This study compared the effects of remimazolam and sevoflurane on intraoperative hemodynamics including intraoperative hypotension (IOH). RESULTS: This study involved adult patients undergoing noncardiac surgery using remimazolam (Group R) or sevoflurane (Group S) for maintenance anesthesia, and invasive arterial pressure measurements, from September 2020 to March 2023 at our hospital. IOH was defined as a mean blood pressure < 65 mmHg occurring for a cumulative duration of at least 10 min. A 1:1 propensity score-matching method was used. The primary endpoint was the occurrence of IOH, and the secondary endpoints were the cumulative hypotensive time, incidence of vasopressor use, and dose of vasopressor used (ephedrine, phenylephrine, dopamine, and noradrenaline). Group R comprised 169 patients, Group S comprised 393 patients, and a matched cohort of 141 patients was created by propensity score matching. There was no significant difference in the incidence of IOH between the two groups (85.1% in Group R vs. 91.5% in Group S, p = 0.138). Patients in Group R had a significantly lower cumulative hypotension duration (55 [18-119] vs. 83 [39-144] min, p = 0.005), vasopressor use (81.6% vs. 91.5%, p = 0.023), and dose of ephedrine (4 [0-8] vs. 12 [4-20] mg, p < 0.001) than those in Group S. There were no significant differences in the doses of other vasopressors between groups. CONCLUSIONS: Compared with sevoflurane, the maintenance of anesthesia with remimazolam was not associated with a decreased incidence of IOH; however, it reduced the cumulative hypotension time, incidence of vasopressor use, and dose of ephedrine.
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BACKGROUND: We herein present a case of venous thrombosis that developed more than 20 years after diagnosis of granulomatosis with polyangiitis (GPA), although many reports of GPA have described venous thrombosis within 1 year of diagnosis. CASE PRESENTATION: A 73-year-old man with GPA was admitted for lower extremity swelling and diagnosed with venous thrombosis and pulmonary embolism. On the second day, catheter-based thrombolysis was unsuccessful, and inferior vena cava filter insertion and anticoagulation were performed. On the third day, respiratory disturbance and loss of consciousness appeared and progressed. The patient died on the fifth day. The autopsy revealed a large thrombus in the inferior vena cava filter, and death of progressive venous thrombosis was suspected. CONCLUSIONS: We experienced a case of venous thrombosis that developed 20 years after diagnosis of GPA, although GPA is frequently associated with venous thrombosis immediately after diagnosis. The thrombosis progressed rapidly and was resistant to treatment.