A Survey of Clinician‐Reported Management of Hypernatremia in the
ICU
Hans Eric Sebastian Seitz‐Rasmussen, Morten H. Bestle, Olav Lilleholt Schjørring, Andrew Ratcliffe, Aoife O'Grady, Jonathan Silversides, Marcus Broman, Peter Bentzer, Pedro Povoa, Johanna Hästbacka, Kristian Strand, Paul Young, Niels Van Regenmortel, Carmen A. Pfortmüller, Manu L. N. G. Malbrain, Ahmad Nasser, Martin Sigurdson, Meint Volbeda, Sine Wichmann, ABSTRACT
Background
Hypernatremia is frequent in the intensive care unit (ICU) and is associated with adverse outcomes. Despite its prevalence, robust evidence to guide treatment is lacking, and global practice patterns are largely unknown. We investigated global treatment preferences and clinicians' willingness to enroll patients in a randomized trial to inform its feasibility.
Methods
This international cross‐sectional online survey comprised 20 primarily closed‐ended questions, using five‐point Likert‐scale responses, across four themes: treatment method, threshold, correction rate, and opinion on a proposed trial. Respondents considered a clinical vignette of hypernatremia developing before or during ICU admission, excluding dehydration and chronic causes. It was distributed to ICU physicians worldwide.
Results
The survey was sent to 3053 ICU physicians in 17 countries, with 1051 respondents, yielding a response rate of 34%. Of respondents, 74% were consultants, and 26% were residents. The mean ICU experience was 14 years. Increasing free water intake via enteral route was the most frequently reported treatment strategy (80% reporting “often” or “always”). Moderate hypernatremia (plasma sodium 151–156 mmol/L) was the most frequently reported threshold for initiating correction (533/892, 60%). 45% (396/888) preferred a correction rate of 8–12 mmol/L/day, and 41% (366/888) of < 8 mmol/L/day, with the remainder having no correction rate target or correction rate target of > 12 mmol/L/day. 74% (654/882) reported no barriers to enrolling eligible patients in the proposed trial.
Conclusion
Among ICU physicians, correction of hypernatremia is mostly achieved by increasing free water intake using hypotonic fluids, predominantly via the enteral route. Most clinicians initiate treatment once hypernatremia reaches a moderate level, aiming for a correction rate of < 12 mmol/L/day. Most clinicians expressed willingness to enroll eligible patients in the proposed trial.
Editorial Comment
This survey study aimed to sample physician preferences for treatment of hypernatremia when on their way to or in the ICU. This study sampled respondents in many countries, and based on different phases of treatment and assessment, as well as participant willingness for a future treatment trial.