Effect of Sodium Supplements and Climate on Dysnatremia During Ultramarathon Running.

OBJECTIVE: Analyze the effect of sodium supplementation, hydration, and climate on dysnatremia in ultramarathon runners. DESIGN: Prospective observational study. SETTING: The 2017 80 km (50 mile) stage of the 250 km (150 mile) 6-stage RacingThePlanet ultramarathon in 2017 Chilean, Patagonian, and 2018 Namibian, Mongolian, and Chilean deserts. PARTICIPANTS: All race entrants who could understand English were invited to participate, with 266 runners enrolled, mean age of 43 years (± 9), 61 (36%) females, average weight 74 kg (± 12.5), and average race time 14.5 (± 4.1) hours. Post-race sodium collected on 174 (74%) and 164 (62%) participants with both the blood sample and post-race questionnaire. INTERVENTION: Weight change and finish line serum sodium levels were gathered. MAIN OUTCOME MEASURES: Incidence of exercise-associated hyponatremia (EAH; <135 mmol·L-1) and hypernatremia (>145 mmol·L-1) by sodium ingestion and climate. RESULTS: Eleven (6.3%) runners developed EAH, and 30 (17.2%) developed hypernatremia. Those with EAH were 14 kg heavier at baseline, had significantly less training distances, and averaged 5 to 6 hours longer to cover 50 miles (80 km) than the other participants. Neither rate nor total ingested supplemental sodium was correlated with dysnatremia, without significant differences in drinking behaviors or type of supplement compared with normonatremic runners. Hypernatremic runners were more often dehydrated [8 (28%), -4.7 kg (± 9.8)] than EAH [4 (14%), -1.1 kg (± 3.8)] (P < 0.01), and EAH runners were more frequently overhydrated (6, 67%) than hypernatremia (1, 11%) (P < 0.01). In the 98 (56%) runners from hot races, there was EAH OR = 3.5 [95% confidence interval (CI), 0.9-25.9] and hypernatremia OR = 8.8 (95% CI, 2.9-39.5) compared with cold races. CONCLUSIONS: This was the first study to show that hot race climates are an independent risk factor for EAH and hypernatremia. Sodium supplementation did not prevent EAH nor cause hypernatremia. Longer training distances, lower body mass, and avoidance of overhydration were shown to be the most important factors to prevent EAH and avoidance of dehydration to prevent hypernatremia.

Pneumatosis Intestinalis Predictive Evaluation Study: A multicenter epidemiologic study of the American Association for the Surgery of Trauma.

BACKGROUND: Our group has previously published a retrospective review defining variables predictive of transmural bowel ischemia in the setting of pneumatosis intestinalis (PI). We hypothesize this prospective study will confirm the findings of the retrospective review, enhancing legitimacy to the predictive factors for pathologic PI previously highlighted. METHODS: Data were collected using the Research Electronic Data Capture. Forward logistic regression was utilized to identify independent predictors for pathologic PI. Statistical significance was defined as p ≤ 0.05. RESULTS: During the 3-year study period, 127 patients with PI were identified. Of these, 79 had benign disease, and 49 pathologic PI defined by the presence of transmural ischemia during surgical exploration or autopsy. Laboratory values such as elevated international normalized ratio (INR), decreased hemoglobin, and a lactate value of greater than 2.0 mmol/L were predictive of pathologic PI, as well as clinical factors including adynamic ileus, peritoneal signs on physical examination, sepsis, and hypotension. The location was also a significant factor, as patients with small bowel PI had a higher incidence of transmural ischemia than colonic PI. On multiple logistic regression, lactate value of greater than 2.0 mmol/L (odds ratio, 5.1, 1.3-19.5; p = 0.018), elevated INR (odds ratio, 3.2, 1.1-9.6; p = 0.031), peritonitis (15.0, 2.9-78; p = 0.001), and decreased hemoglobin (0.70, 0.50-0.97, 0.031) remained significant predictors of transmural ischemia (area under the curve, 0.90; 0.83-0.97). A lactate value of 2.0 mmol/L or greater and peritonitis are common factors between the retrospective review and this prospective study. CONCLUSIONS: We recommend surgical exploration to be strongly considered for those PI patients presenting also with a lactate greater than 2 mmol/L and/or peritonitis. We suggest strong suspicion for necrosis in those patient with PI and small bowel involvement, ascites on computed tomography scan, adynamic ileus, anemia, and a high INR. LEVEL OF EVIDENCE: Prognostic study, level II; therapeutic study, level II.

Venovenous extracorporeal life support improves survival in adult trauma patients with acute hypoxemic respiratory failure: a multicenter retrospective cohort study.

BACKGROUND: Venovenous extracorporeal life support (VV ECLS) has been reported in adult trauma patients with severe respiratory failure; however, ECLS is not available in many trauma centers, few trauma surgeons have experience initiating ECLS and managing ECLS patients, and there is currently little evidence supporting its use in severely injured patients. This study seeks to determine if VV ECLS improves survival in such patients. METHODS: Data from two American College of Surgeons-verified Level 1 trauma centers, which maintain detailed records of patients with acute hypoxemic respiratory failure (AHRF), were evaluated retrospectively. The study population included trauma patients between 16 years and 55 years of age treated for AHRF between January 2001 and December 2009. These patients were divided into two cohorts as follows: patients who received VV ECLS after an incomplete or no response to other rescue therapies (ECLS) versus patients who were managed with mechanical ventilation (CONV). The primary outcome was survival to discharge, and secondary outcomes were intensive care unit and hospital length of stay (LOS), total ventilator days, and rate of complications requiring intervention. RESULTS: Twenty-six ECLS patients and 76 CONV patients were compared. Adjusted survival was greater in the ECLS group (adjusted odds ratio, 0.193; 95% confidence interval, 0.042-0.884; p = 0.034). Ventilator days, intensive care unit LOS, and hospital LOS did not differ between the groups. ECLS patients received more blood transfusions and had more bleeding complications, while the CONV patients had more pulmonary complications. A cohort of 17 ECLS and 17 CONV patients matched for age and lung injury severity also demonstrated a significantly greater survival in the ECLS group (adjusted odds ratio, 0.038; 95% confidence interval, 0.004-0.407; p = 0.007). CONCLUSION: VV ECLS is independently associated with survival in adult trauma patients with AHRF. ECLS should be considered in trauma patients with AHRF when conventional therapies prove ineffective; if ECLS is not readily available, transfer to an ECLS center should be pursued. LEVEL OF EVIDENCE: Therapeutic study, level III.