Induced hypernatremia and hyperosmolarity is protective in animal models of lung injury. We hypothesized that increasing and maintaining plasma sodium between 145 and 150 mmol/l in patients with moderate-to-severe ARDS would be safe and will reduce lung injury. This was a prospective randomized feasibility study in moderate-to-severe ARDS, comparing standard care with intravenous hypertonic saline to achieve and maintain plasma sodium between 145 and 150 mmol/l for 7 days (HTS group). Both groups of patients were managed with lung protective ventilation and conservative fluid management. The primary outcome was 1-point reduction in lung injury score (LIS) or successful extubation by day 7. Forty patients were randomized with 20 in each group. Baseline characteristics of severity of illness were well balanced. Patients in the HTS group had higher plasma sodium levels during the first 7 days after randomization when compared with the control group (p = 0.04). Seventy five percent (15/20) of patients in the HTS group were extubated or had ≥ 1-point reduction in LIS compared with 35% (7/20) in the control group (p = 0.02). There was also a decrease in length of mechanical ventilation and hospital length of stay in the HTS group. We have shown clinical improvement in patients with moderate-to-severe ARDS following induced hypernatremia, suggesting that administration of hypertonic saline is a safe and feasible intervention in patients with moderate-to-severe ARDS. This suggests progress to a phase II study. Clinical Trial Registration Australian and New Zealand Clinical Trials Registry (ACTRN12615001282572)

中文翻译：

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中重度 ARDS 患者诱发的高钠血症：一项随机对照研究

诱导的高钠血症和高渗透压在肺损伤的动物模型中具有保护作用。我们假设在中重度 ARDS 患者中增加和维持血浆钠浓度在 145 和 150 mmol/l 之间是安全的，并且会减少肺损伤。这是一项针对中度至重度 ARDS 的前瞻性随机可行性研究，将标准护理与静脉高渗盐水进行比较，以达到并维持血浆钠浓度在 145 至 150 mmol/l 之间达 7 天（HTS 组）。两组患者均采用肺保护性通气和保守液体管理。主要结果是第 7 天肺损伤评分 (LIS) 降低 1 分或成功拔管。40 名患者随机分配，每组 20 名。疾病严重程度的基线特征得到了很好的平衡。与对照组相比，HTS 组患者在随机分组后的前 7 天内具有更高的血浆钠水平（p = 0.04）。与对照组中的 35% (7/20) 相比，HTS 组中 75% (15/20) 的患者拔管或 LIS 降低 ≥ 1 分 (p = 0.02)。HTS 组的机械通气时间和住院时间也有所减少。我们已经证明诱导高钠血症后中重度 ARDS 患者的临床改善，表明给予高渗盐水是中重度 ARDS 患者安全可行的干预措施。这表明 II 期研究的进展。临床试验注册澳大利亚和新西兰临床试验注册 (ACTRN12615001282572)