February 8, 2023

Presentation by Brittany Waring, RN, BSN, MSN student at Sigma Theta Tau International’s Nursing Odyssey Conference, Nov. 13, 2014. Using hypertonic saline solution (HSS) with IV furosemide (Lasix) improves urine output, weight loss, decreases re-hospitalization rates, hospital length of stay, all-cause mortality, and improves renal function and patient quality of life.

Hi really excited to be here to present to you i actually gave up a few days in hawaii to be here so everything exact but i’m talking to you about using hypertonic saline solution and for a semi or lasix iv to generate patients with heart failure in the hospital setting so heart failure of course is when the heart is not pumping effectively enough to meet the demands

Of the organs and usually the fluids and back stop either into the lungs or into the rest of the body resulting in shortness of breath or peripheral edema swelling the feet or assign users things like that and it is the most common reason for hospitalization among patient over 65 and as we were just talking about heart failure you can see it is very it’s a very

Prevalent issue i’m very expensive so why this topic well i used to work on the credit thoracic icu and there after heart surgery we usually give the patient’s albumin and lasix to health and ivories but then when i moved across the hall to the cardiology floor i found that we only used lasix to die obese patients have not albumin i thought well why is that so i

Looked into research and look like there wasn’t really anything about using albumin but there was this stuff about hypertonic solution so basically salt water to help you with this diaeresis so i pico question which what is a pico question eco stands for population intervention counter intervention and outcomes and it helps you to focus your study so my population

Will be acute decompensated heart failure patients intervention hypertonic saline solution liz furosemide counter intervention was first night alone and then the outcomes that will outcome i was most interested in at the time was increased i rhesus so then i went through the literature search through the different things looked at my primary research and synthesized

It and looked at my secondary research which was the integrative things like you’re made of analyses or your systematic reviews things like that and then you apprised the prey bags and decide live as well and then compare it with the recommendations that are currently available and then derive implications for practice so i took my surgical literature looking at

Ebsco premier sources databases as well as specifically pubmed as you can see here by my flowsheet i started off with 402 articles of a screen only 12 of those are actually relevant to my topic and then i remove the duplicates so there are only seven unique articles and out of those seven four of them were already included i use so i ended up with bullying free

Articles so as you can see there’s not a lot of literature out there we really need more of this stuff so the first article of lol one cat is entitled intravenous salt supplementation with low-dose furosemide for treatment of acute decompensated heart failure mrs. bye boo goo hara at all 44 patients were randomly assigned to their control and experimental groups the

Experimental group received 40 milligrams of lasix in 500 milliliters of one-point-seven percent san lien the control group received the same dose of person i’ve been in 500 milliliters of 5% glucose solution and what they found was that the urinary volume was greater in the sultan fusion group but weight loss was also greater in the salt infusion group and 24 hours

After treatment the estimated lemare allure filtration rate or egfr was greater in the salt infusion group as well so it appears that this salt helps to improve renal blood flow and renal function so then let’s take a look at another study which was done in two thousand small volume hypertonic stay on hi joseph first night on the treatment of a factor refractory

Congestive heart failure of this bike at araneta tall 30 ish it’s 20 miles 10 females age 65 to 85 years with refractory new york heart association class for chf were used and there was not actually a designated control group the patient’s active as their own control actually because they were unresponsive to oral lasix prior to the study so these participants

Received actually quite a bit simplistic that in 150 milliliters of one-point-four percent 24.6 per cents feeling solutions which they decided to dose based on the patient’s serum sodium for the day and they combine that with their dose of gross amide which range from 1 125 2000 milligrams twice a day for six to 12 teams whichever which was the duration of the

Hospitalization and they found again that there is a significant increase in the mean daily data recent there is also a significant mean body weight reduction on between two groups and the range of weight lost was between five 20 kilograms so the results showed improvement in clinical signs and symptoms of congestion in all participants as well and an improvement

In the new york heart association functional class so most of these actually all of these patients were in class for functional which is very beyond words there is and 15 patients achieved a class 2a 13 of them also achieved a class 2b and then the final two patients achieved class three prior to discharge so most patients would from fast-forward to class two from

This treatment and then they continue to maintain that same functional class for the following to follow for follow up period this is amazing in gascony including that 12-month follow-up period none of those patients will be possible of that green hospitalized and there was there was a twenty percent mortality rate but compared with previously published rates of

Fifty percent that’s actually pretty good and three of these patients so six total died out of in that 12-month follow-up period three of which were cardiac causes three and the other three were now cardiac causes at all could then car accident and they did not specify so let’s let’s sum up what we’ve discovered so far is that both of these articles have showed

Increased diuresis when you use the hypertonic saline solution and the lasix there’s also increased urine volume and they both postulate that it increases renal blood flow which leads to the improved diuresis and neither study reported any adverse events among the participants so it appears that this is highly beneficial and very low-risk treatment for these

Patients here’s a graph the mean 24 hour diuresis in those two studies the yellowish green is when patients did not use the hypertonic saline solution and then you bar it is when they were using hypertonic saline solution you can see how great the differences between the two groups then on to our integrated analysis this is somatic review of gandhian male admirers

Entitled hypertonic saline with furosemide for the treatment of acute congestive heart failure a systematic review and meta-analysis they used ten studies all studies contain a control group and wolf dad showed significant results there was decreased mortality decrease and readmission rates and decrease in the hospital length of stay about three days increase and

Weight loss and improve your renal function supposed to decrease renal function which is what we usually see with prolonged lasix use no adverse events were recorded with any of these states as well so with our primary evidence and their secondary evidence together we find that they they all support what each other has found which is that the use of hypertonic

Saline solution and id lasix versus latex alone is really quite effective it improves diuresis and weight loss it improves your renal function it decreases hospital readmission rates decrease its hospital length of stay and decreases all cause mortality now this is something that seems very it’s very counterintuitive to us we’re very um it’s been ingrained in as

The low salt this way to go low salt you must decrease your salt so that you don’t have increased water retention and all these things but it seems that that might not be the end of the story right there so a question of course the current guidelines are what we do what we do in hospital right now we give increasingly increased doses of lasix or other diuretics

That are very powerful and actually are nephrotoxic and we also restrict so the end of the diet so those are current guidelines opposite from overseeing research here so does it make sense that this seemed like something that could actually happen in the human body well is the results suggest of treating a patient with hypertonic saline in addition a person is

More effective and it’s probable that the hypertonic saline it increases the tonicity of the plasma which draws the extracellular fluid into the vascular space then the research documents an increased call mary filtration rate which causes a greater amount of fluid to be filtered out of the blood and then the lasix then works to keep that fluid for gangrene’s more

The limitations of this there is no grey literature included so there’s of course miss positive publication bias if you have negative results you’re probably less likely to be published so i probably didn’t see your work but also a majority of these trials were conducted in the same place of the patera net all study was conducted in italy as for several of the

Studies that were included in the men in our lives so let’s go over once again what we gained from this so many more research to back this up especially in large multi-center controlled trials hypertonic saline solution seems to really give significant benefit with metal risk when used with iv lasix this treatment has really high potential to increase diaeresis

And decrease rock rehospitalization and death among part of your patients and it has shown a durable benefit and increase in the quality of life an improved functional class when x which extended well beyond the acute intervention which is huge do we have any question but i’d like to underline it that this is also very cheap especially when considering that this

Is a bag of salt water that nobody can you can’t patent it you can’t sell it i’m just going to make a big profit off of it your pharmacist is going to mix it up for you so that’s for a cheap you probably need a central line or a client lebra’s but also when compared with the hospital baby but it’s protecting that’s also through the pales in comparison pretty cheap

I just wondered um would this be how many treatments would they have to have they would be dumped in the hospital it’s done in the hospital and i think if they continue the treatments until they reach the desired effect so it depends on the patient how much fluid you have to lose how quickly do you respond to the treatment mostly it looks like the treatments even

Twice a day so it could be done in an acute care setting you don’t need to be nice you twice a day is a little much to say go into an appt patient infusion center but some of these depending on your your severity it could take you three to six days i maximal most 12 days but also the maximum weight loss in that studies one so with that one study yet however i’m

Good i’m not sure they didn’t specify that wasn’t a trip so i think it was mixed in with the solution however in the oklahoma study it was only that 40 milligrams and they still saw very very positive results

Transcribed from video
Hypertonic Saline and Furosemide to Diurese Heart Failure Patients By Brittany Waring