Hypertonic saline for the management of raised intracranial pressure after severe traumatic brain injury

Annals of the New York Academy of Sciences
Halinder S Mangat, Roger Hartl

Abstract

Hyperosmolar agents are commonly used as an initial treatment for the management of raised intracranial pressure (ICP) after severe traumatic brain injury (TBI). They have an excellent adverse-effect profile compared to other therapies, such as hyperventilation and barbiturates, which carry the risk of reducing cerebral perfusion. The hyperosmolar agent mannitol has been used for several decades to reduce raised ICP, and there is accumulating evidence from pilot studies suggesting beneficial effects of hypertonic saline (HTS) for similar purposes. An ideal therapeutic agent for ICP reduction should reduce ICP while maintaining cerebral perfusion (pressure). While mannitol can cause dehydration over time, HTS helps maintain normovolemia and cerebral perfusion, a finding that has led to a large amount of pilot data being published on the benefits of HTS, albeit in small cohorts. Prophylactic therapy is not recommended with mannitol, although it may be beneficial with HTS. To date, no large clinical trial has been performed to directly compare the two agents. The best current evidence suggests that mannitol is effective in reducing ICP in the management of traumatic intracranial hypertension and carries mortality benefit compared ...Continue Reading

References

Feb 1, 1978·Journal of Neurosurgery·L F MarshallH M Shapiro
Oct 1, 1992·Journal of Neurosurgery·A M Kaufmann, E R Cardoso
Jul 1, 1986·Journal of Neurosurgery·F Nath, S Galbraith
Nov 1, 1984·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·M L SchwartzD F Andrews
Oct 1, 1981·Journal of Neurosurgery·A M BurkeC Cerri
Apr 13, 1996·BMJ : British Medical Journal·D R Jeevaratnam, D K Menon
Sep 1, 1996·Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine·M R SayreJ M Hurst
Jan 6, 2007·Critical Care Medicine·Thomas J K ToungAnish Bhardwaj
Jan 23, 2008·Critical Care Medicine·Gilles FranconyJean-Francois Payen
Feb 15, 2008·Neurology·M A KoenigR D Stevens
Dec 15, 2010·American Journal of Physiology. Heart and Circulatory Physiology·Robert FrithiofClive N May
Nov 1, 2011·Critical Care : the Official Journal of the Critical Care Forum·Antoine RoquillyKarim Asehnoune
Dec 14, 2012·The New England Journal of Medicine·Randall M ChesnutUNKNOWN Global Neurotrauma Research Group
Jul 5, 2013·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·David D GondaMichael L Levy
Oct 9, 2013·Journal of Neurosurgery·Linda M GerberJamshid Ghajar
Jun 11, 2014·Journal of Neurotrauma·Celeste DiasMarek Czosnyka

❮ Previous
Next ❯

Related Concepts

Related Feeds

Brain Injury & Trauma

brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.